2018 Pregnancy and Birth PDF

& Birth
H E A LT H Y PA R E N T S , H E A LT H Y C H I L D R E N
& Birth 2 nd E D I T I O N
Because they don’t come with a manual
healthyparentshealthychildren.ca
This book belongs to:
Your baby’s due date:
My important contact information

Health care provider
Name:
Phone:
Birth centre/hospital
Name:
Phone:
Community or public health centre
Name:
Phone:
Other:
Name:
Phone:
This book has lots of information to help you through your

pregnancy and prepare you for your baby.
The content in this book reflects Alberta

Health Services’ (AHS) information Follow us on
at the time of printing. For more /healthyparentshealthychildren
information and regular updates visit @AHS_HPHC
Copyright © (2013) Second Printing (2014) Third Printing (2018) Second Edition (2018) Alberta Health Services. This material
is protected by Canadian and other international copyright laws. All rights reserved. These materials may not be copied,
published, distributed or reproduced in any way in whole or in part without the express written permission of Alberta Health
Services. These materials are intended for general information only and are provided on an ‘as is’, ‘where is’ basis. Although
reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any
representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for
a particular purpose of such information. These materials are not a substitute for the advice of a qualified health professional.
Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or
suits arising from such use.
ISBN 978-0-9916769-1-0
Table of Contents
INTRODUCTION 3
Important Contact Information 3

Important Websites 4
Your Book 5
Thank You! 8
AN OVERVIEW OF PREGNANCY 9
Becoming a Parent 11
Growing Together 16
The Developing Brain 19
S TA R T I N G O F F H E A LT H Y 21
Growing Together 23
Prenatal Care 24
Healthy Body and Mind 26
Being Safe 75
Planning Ahead 85
FIRST TRIMESTER: THE BEGINNING 89
Growing Together 91
Prenatal Care 103
If Pregnancy Doesn’t Go as Expected 108
SECOND TRIMESTER: THE MIDDLE 111
Growing Together 113

Prenatal Care 123
Planning Ahead 126

Healthy Parents, Healthy Children | Pregnancy and Birth 1
THIRD TRIMESTER: THE FINAL STRETCH 143
Growing Together 145

Prenatal Care 154
Planning Ahead 156
LABOUR & BIRTH: THE BIG EVENT 163
Knowing What to Expect 165

Three Stages of Labour 171
First Stage of Labour: Contractions, Thinning and Opening of the Cervix 172
Second Stage of Labour: Birth 190
Third Stage of Labour: Separation and Delivery of the Placenta 192
Pain Relief Options During Labour 193
Other Procedures During Labour and Birth 196
P O S T PA R T U M : T H E FI R S T 6 W E E K S 205
Congratulations Your Baby is Here! 207

At the Birth Centre 208
Your First Few Weeks at Home 224
Healthy Relationships 253
BREASTFEEDING 273
Breastfeeding Your Baby 275

Breastfeeding Basics 279
The First Week and Beyond 286
Expressed Breastmilk 293
Challenges and What to Do 307
T H E E A R LY Y E A R S 321
INDEX 323
2 Pregnancy and Birth | Healthy Parents, Healthy Children

Important Contact Information
INTRODUCTION
No cost services available in many languages
Emergency Services Health Link

Ambulance, Fire and Police Health advice from a registered nurse.
911 811
Available 24/7 Available 24/7
Addiction AlbertaQuits Helpline Bullying Helpline

Services Helpline Tobacco cessation counsellors Advice or support
Help for problems with can help you make a plan on bullying.
gambling, alcohol, tobacco to quit, manage cravings 1-888-456-2323
and other drugs. and stay on track.
bullyfreealberta.ca
1-866-332-2322 1-866-710-7848 Available 24/7
Available 24/7 albertaquits.ca
8am–8pm
Child Abuse Family Violence Income Support

Hotline Info Line Contact Centre
Hotline to report child Provides information about Financial help for
neglect or abuse. family violence programs Albertans who don’t have
1-800-387-5437 and services, as well as the resources to meet their
advice and support. basic needs (e.g., food,
Available 24/7 clothing, shelter).
310-1818
Available 24/7 1-866-644-5135
Available 24/7
Medication & Mental Health Poison & Drug

Herbal Advice Line Helpline Information Service
Advice and information Offers help for mental health Confidential advice about
about medicine and concerns for Albertans. poisons, chemicals,
herbal products from 1-877-303-2642 medicine and herbal
pharmacists and nurses. products.
Available 24/7
1-800-332-1414 1-800-332-1414
Available 24/7 Available 24/7

Important Websites
ahs.ca ahs.ca/options covenanthealth.ca
Alberta Health Know Your Options Covenant Health
Services (AHS) Get the care you need Catholic service
Canada’s largest integrated when you need it. The provider within Alberta’s
health system, responsible best place to start is with healthcare system,
for promoting wellness Health Link at 811 or your with 17 facilities in
and providing health care family doctor. There are 12 communities.
across the province. other options depending
on what you need.
myhealth.alberta.ca alberta.ca immunizealberta.ca

Your resources for To find the Alberta For information on
non-emergency health Government services and Alberta’s routine
information and tools. information you need. immunization schedule
and the answers to
frequently asked
questions.
Find information from Healthy Parents, Healthy Children: Pregnancy and Birth and
Healthy Parents, Healthy Children: The Early Years online with many interactive
features. Browse on a smart phone, tablet or computer.
readyornotalberta.ca
Deciding to become pregnant is a big decision for both men and women.
Whether you’re ready for another baby or not, it’s healthy to have a plan.

Your Book
INTRODUCTION
Congratulations, you have a baby on the way! Now what happens? You can read this
book to find out. This made-in-Alberta resource will help you with the many changes that
are coming. We’ll take you from the early stages of pregnancy, “It’s true, we’re pregnant!”,
through the thrill of your baby’s birth, “It’s a boy!” or “It’s a girl!”, and into your baby’s first few
weeks, “What do we do now?”.
There’s a lot of information out there on pregnancy and birth. However, too much
information can be confusing, especially when you hear different things from different
sources. This book is based on today’s knowledge, evidence and best practices. We
“
asked expectant and new parents what
they wanted to learn and we asked health
Use the book (Pregnancy and
experts from across Alberta to help write
Birth) and Health Link (811).
this book. We encourage you to balance the
”
information you find here with your own You basically have help at your
knowledge, values, skills and instincts to fingertips 24 hours a day!
help you have the healthiest pregnancy and
~ Rachel, mom of a toddler
baby possible.
This book is a resource intended to guide you through the journey of pregnancy and birth.
It will help prepare you for each trimester, labour and birth, and life after you have your
baby. If you’re a partner or support person of a pregnant woman, reading this pregnancy
and birth book will help you understand and relate to what your pregnant partner is going
through and how you can best
support them. There are also special
sections for partners and support
persons to prepare you for your role
in pregnancy, labour and birth, and
parenting.
Families are as unique as the people

in them. Your family might include a
mother and father, same-sex parents,
adoptive parents, foster parents,
grandparents, brothers, sisters, aunts,
uncles or close friends living together
or on their own. This book is for you
and your family!

How to use this book
In this book, you’ll find:
■■ An Overview of Pregnancy gives you a general look at pregnancy and the many
changes you can expect.
■■ Starting Off Healthy tells you what you need to know so that you, your partner and
your baby can be healthy during your pregnancy and later on. Health information
related specifically to a trimester, labour and birth, postpartum or breastfeeding will be
found in those chapters.
■■ First Trimester, Second Trimester and Third Trimester are separate chapters that tell
you about the changes during each trimester and offer some practical tips for common
discomforts.
■■ Labour & Birth: The Big Event tells you about the process of labour and birth, ways
to work with your body’s natural instincts and many helpful coping and comforting
strategies.
■■ Postpartum: The First 6 Weeks tells you about caring for yourself during the first six
weeks and the first few days with your baby.
■■ Breastfeeding gives you information about how to breastfeed your baby and how to
deal with common challenges.
We let you know throughout this book when we have additional information that is
available on our website. When you see Links, Videos, Tools or Printables, simply visit
healthyparentshealthychildren.ca/resources to learn more.
We refer to your baby as ‘your baby’, no matter how many weeks pregnant you are.
We refer to hospitals and midwifery run birth centres as ‘birth centres’.

You’ll also find:
INTRODUCTION
words that you may not know are green and have definitions at the bottom of the page
“
■■
”
■■ quotes from Alberta parents
■ text boxes that highlight:
Things to know Helpful activities
If you’re a partner
■■ text boxes that describe when to ask for help:
! !!
Call Health Link at 811 or Call 911 or go to the
your health care provider Emergency Department
within 4–6 hours NOW
■■ QR codes you can scan with your smart phone to link directly to more information. In
some devices a QR reader is built into your phone’s camera.
1. Open a QR code reader on your smart phone.

2. Hold your device over a QR code so that it’s clearly visible within
your screen.
3. If necessary, press the button to scan.

Healthy Parents, Healthy Children:
The Early Years book
We’ve also written another book for you called Healthy Parents, Healthy Children: The Early
Years. It picks up where this book leaves off. The Early Years will help guide you from the
newborn stage up to your child’s 6th birthday. If you did not receive both of these books
as a set, you can get a copy from a community or public health centre. Information from
both books is available at healthyparentshealthychildren.ca
Thank You!
We want to thank the many expectant and new parents who shared their ideas and
experiences with us. We also want to thank the health care providers and experts from
across Alberta for their dedication and valuable contributions to the content development
and review of the Healthy Parents, Healthy Children resources.
We also wish to acknowledge these organizations from which we adapted content:

■■ Health Canada
■■ Government of Alberta
■■ Society of Obstetricians and Gynaecologists of Canada
■■ Managing Mental Health Conditions During Pregnancy and Early Parenthood—A guide for
women and their families (Beyond Baby Blues, Australia)
■■ Palix Foundation
■■ The Early Prenatal Risk Assessment Program (multidisciplinary collaborative of Elliott
Fong Wallace & Associates; Specialists in Diagnostic Imaging; Calgary Laboratory
Services and the Calgary Zone; Departments of Obstetrics and Gynecology and
Medical Genetics)

An Overview
of Pregnancy
9
An Overview of Pregnancy
Welcome to the next nine months and beyond! In this chapter, you’ll learn
about the three trimesters that make up nine months of pregnancy. We’ll
introduce you to some of the many changes you can expect during this
parenting journey. Our goal is to help you have the healthiest pregnancy
possible to get your baby off to the best start.
10
Becoming a Parent
AN OVERVIEW OF PREGNANCY
“You’re going to have a baby!” Everyone reacts differently when they hear these words. You
may be very excited about the news and look forward to having a baby. You may not feel
ready to become a parent, even if you’re excited about the baby. This is a big change in
your life. Becoming a parent is a big step.
Parenting is the art of raising a child. It starts in pregnancy, long before your baby is born.
You can look to this book or visit healthyparentshealthychildren.ca to answer
many of your questions about pregnancy, birth and the first few weeks. After
your baby arrives, information from birth up to 6 years of age can be found in
the book Healthy Parents, Healthy Children: The Early Years or online.
Attachment begins in pregnancy

Even before your baby is born, you start building an emotional connection with each other
called attachment. Having a healthy attachment to a parent is essential for your baby to
learn to trust and form healthy relationships with others. For the first few months of your
pregnancy, you may not yet connect with your baby. The fact that you’re going to have a
baby may or may not seem real to you until you feel your baby move, see your baby on an
ultrasound, or hold your baby in your arms.
During the second trimester, your baby

will begin to hear and recognize voices.
Talking to your baby helps make your
attachment stronger. Singing to your
baby and gently stroking your abdomen
can also help you build attachment. Tell
your baby how excited you are to meet
them. Tell them what names you’re
thinking about, and what you’re learning
as you read this book.
In your second trimester, you’ll feel your baby move. In your third trimester, others will
be able to see and feel your baby moving too. As your baby’s due date gets closer, you
may feel even more connection with them. Many women have an urge to ‘nest’. Nesting
is an instinct to make your home safe and secure, as you get ready to welcome your
baby home.
attachment: the two-way emotional connection between you and your baby
ultrasound: a scan done to check on the health and development of your baby and pregnancy

Here are some other suggestions to help you connect with your baby:
■■ Plan how and when you’ll share the
pregnancy news with friends and family. If you’re a partner
■■ Read magazines and books, like this one, You may or may not feel connected
about pregnancy and parenting. to your baby yet. You may not feel
a connection until you feel your
■■ Think about the kind of parent you want baby kick or move. This is common;
to be. be assured you can develop your
connection to your baby in many
■■ Talk with your partner about how you
ways, over time. Look for tips on how
were each raised and what kind of
to connect throughout this book.
parents you want to be.
■■ Consider going to prenatal or parenting
classes.
■■ Watch the parents around you—think
about what you like about how they take
care of their children.
■■ Talk with other parents.
■■ Talk with your partner about how you’re
both feeling and as these feelings change
over time.
Ways to support a pregnant woman

As a partner, friend or family member, there are many ways you can support a
pregnant woman:
■■ Read pregnancy, birth, breastfeeding ■■ Talk about ways you can help during
and parenting books. labour and birth. Practice exercises,
■■ Go to prenatal check-ups together and massage, positioning and relaxation
ask questions. with her.
■■ Go to childbirth education and

■■ Make healthy lifestyle choices together.
breastfeeding classes together. ■■ Keep a positive outlook.
■■ Learn about the birth centre together. ■■ Help with tasks that she’s no longer able
■■ Ask what supports she needs during to do.
pregnancy. ■■ Talk positively about her changing body.

Parenting with others
As you begin to think about being a parent, you’ll
realize that this also involves many decisions—
including who will be involved in raising your child.
If you’ll be parenting with a partner, talk about what
each of you liked about your childhood, and how
you were raised, and how you would like to parent.
Here are some things you may want to think about:

■■ your hopes and dreams for your child
■■ the kind of relationship you want to have with
your child
■■ your expectations of yourself and your partner
■■ how you plan to handle conflict with your child
and each other
■■ what you’ll need for child care and what your
options are
You may think of parenting strategies and Learn about pregnancy and
traditions you want to continue and others that parenting. Talk about the kind
you want to change. If there are things you want of parent you want to be.
to do differently from the way you were raised,
there are many parenting programs that can help you learn new skills. Talk with your health
care provider or call Health Link at 811 to find out about programs in your area.
Parenting without a partner

If you do not have a partner, there are other people who can help give you the support
you need. Think about those around you. Do you have a friend, parent or sibling who can
share the joys and stresses of pregnancy and parenting with you? You may want to ask
yourself these questions:
■■ Who would I like to help me during pregnancy? During childbirth? After my baby
is born?
■■ What kind of support do I need now? In childbirth? After my baby is born?
■■ Who do I trust to help me, even when I’m tired or cranky?

Your life will change after having a baby and different things will be important to you.
Now is a great time to think about how you can get the support you need during your
pregnancy and parenthood.
If you’re not in a relationship with your baby’s other parent, or you’re no longer married
or living together, there may be additional parenting decisions to make. Some of the
decisions may have to do with how much time each of you has with your child, as well as
child support, schooling, health issues and cultural traditions.
You may be wondering about legal guardianship once your baby is born. A guardian has
the rights and the responsibility to make decisions about a child’s care and how the child
is parented.
To learn more about legal guardianship and the rights and responsibilities legal guardians
have, visit the Links section at healthyparentshealthychildren.ca/resources
If you need legal advice for your own situation, you can speak with a lawyer.
If you have other children

If you have other children, you can help
them get ready to welcome the new
baby. What and when you tell them
depends on how old they are. Telling
your children after the first trimester will
give them time to get used to the idea
of a new baby. After the first trimester,
a miscarriage is also less likely and your
pregnancy may begin to show. If you
haven’t been feeling well in the first
trimester, you may want to tell your older
children that you’re pregnant right away
so they do not worry that you’re sick.
Even though your children may not

notice your growing abdomen, other
people will. Your children will notice any
talk about babies going on around them.
miscarriage: loss of a fetus before 20 weeks of pregnancy

Every child reacts differently to news that a new baby is coming. Some may be worried
that you won’t have time for them, although they might not be able to tell you that. You
may see changes in your child’s behaviour, like wanting to be carried, talking like a baby
again, or suddenly having toileting accidents. All of these are normal changes in children,
and with your love and support they’ll last just a short time. Other children may be very
excited for the baby to come home.
Some children may be curious and ask you “Where do babies come from?” or “How did the
baby get into your tummy?” When talking about where babies come from, try to use words
that your child understands, as well as use the correct names for body parts. For children
around 3 years old, you can say that “Babies grow in a special place inside a mom’s body called
a uterus.” A 6 year old may have more questions about how the baby grows or how it will
come out. You could say something like “A baby grows in the uterus and is born through
the vagina.”
Once you’ve told your children, look for ways to help them feel included in getting ready
for the baby. All children need to feel that they’re wanted and part of the family.
Parenting is a skill you learn as you go. There

are many people, programs and resources Learn more about parenting
that can help you with this learning. You can There is lots of information about
find some of those throughout this book, at parenting available in the Healthy
healthyparentshealthychildren.ca, by calling Parents, Healthy Children: The Early
Health Link at 811 or talking with your health Years book. You’ll learn about:
care provider. Welcome to parenthood! ■■ how children develop and grow
“
■■ what to expect at different ages
and stages
Build your village, have people ■■ what you can do to support
around. So many people don’t have your child’s healthy growth and
family or extended family built development
in so you kind of need to make ■■ how to cope with everyday
your village. It might be friends, challenges
doctors, classes you take—build up You can also visit
”
people you can call or see who can
reassure you.
~ Meena, mom of two children

Growing Together
Pregnancy is about 40 weeks, or 9 months long. Health care providers start counting
pregnancy weeks from the first day of your last menstrual period, not from the day of
conception. This means that when your health care provider says you’re 6 weeks pregnant,
it’s actually only about 4 weeks since you conceived.
Pregnancy is divided into 3 trimesters:
First trimester:
first day of your last
menstrual period up
to 13 weeks
Second trimester:
13 weeks up to 26 weeks
Third trimester:
26 weeks up to 40 weeks
To use an interactive tool on the 3 trimesters, visit the Tools section at

healthyparentshealthychildren.ca/resources
conception: the process of becoming pregnant when an egg and sperm combine to create an embryo (fertilization), or
implant into the wall of the uterus or both

Your body during pregnancy
These are some of the words your health care provider will use when talking about
your pregnancy.
Placenta: The organ that supplies Fetus (baby): Your growing baby from
your baby with oxygen, nutrients and 10 weeks of pregnancy to birth.
hormones. It also removes your baby’s Amniotic fluid and sac (the bag of
waste. It’s delivered after your baby is born. waters): The liquid that surrounds
Uterus: A muscular organ that holds your and cushions your baby. The sac is the
baby, the amniotic sac and the placenta. It’s membrane that surrounds the liquid.
also called the womb. Bladder: The sac that holds urine (pee).
Cervix: The opening at the bottom of the Pelvic bones: The bones of your pelvis
uterus and the top of the vagina. that support the organs in your abdomen.
Rectum: The lower end of the large Urethra: The tube attached to your
intestine (bowel). bladder that your urine passes through
Anus: Where bowel movements (stools) when you urinate.
come out. Vagina: The birth canal that connects the
Umbilical cord: This joins your baby to uterus to the outside world.
the placenta. The cord is cut at birth. Your
baby’s navel (belly button) forms where the
cord falls off.
Placenta
Umbillical cord
Uterus
Fetus (baby)
Cervix
Amniotic fluid and sac
Bladder
Rectum Pelvic bones
Anus Urethra
Vagina
bowel movements: solid waste from the digestive tract.

When is my baby due?
Your health care provider can figure out when your baby is due with the help of an
ultrasound or by using the first day of your last menstrual period.
Remember that a due date is always an estimate. Babies are usually born within 1–2 weeks
of their due date—only 4 out of every 100 babies arrive on that exact day. Babies are full
term when they are born between 37 and 41 weeks.
To help find out your due date using a due date calculator, visit the Tools section at
Twins, triplets and more

Your health care provider will talk with you about the care you’ll need if you’re pregnant
with more than one baby. You’ll have more ultrasounds to make sure your babies are
growing as they should. You’ll also be referred to an obstetrician. Your prenatal visits may
all be with an obstetrician or with a combination of your current health care provider and
an obstetrician.
Expecting more than one baby can be exciting and may bring challenges. You may be
worried about the cost of supporting more than one child, deciding who will help look
after the babies, where to find support and more. To learn more or find a prenatal class,
call Health Link at 811, talk with your health care provider or, visit the Links section at
“ Learning from others helped me

with my pregnancy worries—
whether that was reading books,
talking to other parents through
the Twins, Triplets and More group,
”
and attending the Alberta Health
Services classes.
~ Liz, expectant mom of twins
obstetricians: medical doctors who specialize in caring for pregnant women and help with the birth of babies

The Developing Brain
By understanding how the brain works, you can help your baby grow and develop. A
brain needs a good base to support all future development, just like the house needs a
strong foundation to support the walls and the roof. The most important time for brain
development is during pregnancy and the early years. This is when the foundation is set
for future learning, behaviour and health. This strong base in the early years gives your
child the best start for life. Caring for yourself during pregnancy supports how your baby’s
brain forms and develops.
Your baby’s brain starts to form very early in pregnancy—babies are learning even before
they are born. At birth, your baby’s brain is completely formed, but it’s only about one
quarter the size of an adult’s brain. Even though your newborn’s brain contains billions of
neurons, only a small number of them are connected. The neurons must be connected (or
‘wired’) together for the many parts of their brain to communicate with each other, and for
their brain to be able to communicate with other parts of the body.
5 weeks 11 weeks 20 weeks 40 weeks

of pregnancy of pregnancy of pregnancy of pregnancy
Throughout pregnancy, your baby’s quickly developing brain is very sensitive to harmful
environments, such as too much stress due to abuse, violence, parental addiction or
mental illness. Other things that can impact your baby’s brain include certain illnesses,
and being exposed to chemicals, alcohol, tobacco, tobacco-like products, some kinds of
medicine, cannabis (marijuana, hashish, hash oil) and other drugs.
neurons: nerve cells found in the brain and nervous system

tobacco: any product made from whole or parts of tobacco leaves. This can include cigarettes, cigarillos, cigars, pipe
tobacco, snuff, chewing and dipping tobacco, and shisha or hookah. It doesn’t include any regulated nicotine
replacement therapy products.
tobacco-like products: any product that mimics a tobacco product. This includes the following products that are vaped
or smoked, but are not limited to, cannabis (marijuana), hookah, shisha, electronic cigarettes, vaping pens,
tanks and mods.
other drugs: drugs such ecstasy, methamphetamines, cocaine, heroin and fentanyl

After birth, your baby’s brain develops through relationships and interactions with you,
other people and their environment. Simple connections form first that lead to more
complex pathways. This is what makes it possible for your child to grow, think and learn.
A natural process called synaptic pruning removes brain connections that are not used
often, so their brain can work faster and better. Although the early years are the most
important for laying the foundation, this wiring of their brain takes place in a predictable
order and the process takes about 25–30 years. The brain keeps adapting for the rest of
your child’s life.
There’s more information about caring for yourself during pregnancy in this book.
More information about helping to build your baby’s brain after they’re born can be
found in the book Healthy Parents, Healthy Children: The Early Years or visit
interactions: activities and communication between 2 or more people, or their environment

Starting Off
Healthy

21
Starting Off Healthy
A healthy pregnancy starts with taking care of yourself. The best gift you
can give your unborn baby is a healthy start in life. When you take care of
yourself, you may find labour and birth easier. It may also be easier to return
to your pre-pregnancy weight and activities. This chapter will give you many
ideas on how you and your partner can be healthy during this pregnancy
and later on. The next chapters will provide more information about the
trimesters, labour and birth, postpartum and breastfeeding.
22
Growing Together
S TA R T I N G O F F H E A LT H Y
You can enjoy your pregnancy more and give your baby the best start when you stay
healthy. When you take care of yourself, you give your baby the best chance at being
healthy too.
Some ways for you and your baby to stay healthy are to:
■■ See your health care provider for regular ■■ Learn ways to handle stress and
prenatal care. changing emotions.
■■ Gain a healthy amount of weight. ■■ Prevent infections and injuries.
■■ Eat a variety of healthy foods. ■■ Try to cut down and quit alcohol,
■■ Take a multivitamin with folic acid in it tobacco, tobacco-like products, cannabis
every day. (marijuana, hashish, hash oil) and
other drugs.
■■ Be physically active.
■■ Be aware and reduce household and
■■ Practice healthy posture. workplace hazards.
■■ Take care of your mouth and teeth and ■■ Focus on your relationships with your
see your dentist regularly. partner or support people.
■■ Get the support you need.
You may already be doing these things or you may

want to think about making some lifestyle changes.
Some of these changes may be easy while others
might be harder to make. Think about how they may
affect your life and relationships.
You can look to your partner, your health care

providers and other people in your life to help you
make changes or to maintain your healthy lifestyle.
You can also call Health Link at 811 to find resources
where you live.
folic acid: f olic acid (folate) is a vitamin added to foods (fortification) or vitamin supplements, it is also naturally found in
foods, and helps to prevent neural tube defects

Prenatal Care
Your health care team may include different health care providers. In this book, we refer
to your health care provider as the person who provides most of your health care during
your pregnancy and the first few weeks after your baby is born. Your health care providers
may include:
■■ family doctors: medical doctors who

specialize in caring for the whole family,
including babies. They help with a wide
range of health concerns.
■■ nurse practitioners: registered nurses
with extra training who work as part of a
family medicine team
■■ obstetricians: medical doctors who
specialize in caring for pregnant women
and help with the birth of babies
■■ midwives: registered midwives specialize Whenever possible, go to prenatal
in caring for low-risk pregnant women, checkups together—you can have
help with the birth, and offer care up to 6 your questions answered too. If
weeks after your baby is born you work or live out of town, ask
your health care provider if you can
There may also be other health care take part in the checkup through
providers involved with your family’s health. speakerphone or video chat.
Finding a health care provider

Here are some questions to ask when choosing a health care provider for you and
your family.
■■ Where will my baby be born?—Your Living on a low income
baby may be born in a hospital, in a birth If you’re living on a low income and are
centre, in your home or in a midwife- concerned about making changes to
run birth centre depending upon if a your lifestyle or about having a healthy
family doctor, obstetrician or midwife is pregnancy talk with your health care
providing your care. provider or call Health Link at 811. You
may qualify for resources and programs
■■ Will the health care provider I choose be in your area.
at the birth? If not, who will?

What decisions will I have to make during pregnancy and labour, and how will they be
■■
made?—some tests and procedures will depend on your situation and your health care
provider.
■■ What support will I have after my baby is born, like for breastfeeding?
■■ Are there any charges for services that Alberta Health Care does not cover?
If you do not have a health care provider, ask your friends and family if they know who may
be taking new patients. You can also contact:
■■ Health Link at 811
■■ College of Physicians & Surgeons of Alberta at 1-800-561-3899
■■ Alberta Association of Midwives at 1-888-316-5457
To find a health care provider online, visit the Links section at

Prenatal checkups
Once your pregnancy is confirmed, you’ll begin regular prenatal checkups. These visits are
a good time to ask questions about your health, your baby’s growth and development,
and services in your area. If you have a lot of questions, ask the receptionist to schedule
extra time for your appointment.
Bring a list of your questions and all of the medicine, over-the-counter medicine,
supplements and herbal products that you take. Talk with your health care provider if
you’re using alcohol, tobacco, tobacco-like products, cannabis (marijuana, hashish, or hash
oil) or other drugs.
Talk with your health care provider

about any physical or mental health
issues you have had. You can then
both talk about how to manage them,
which may include medicine and
health treatments.
Your health care provider will let you

know how often you’ll need to come
for prenatal visits. If there are concerns
about your health or your baby’s
health, you may have more visits.
over-the-counter: medicine you buy without a prescription

Healthy Body and Mind
During your pregnancy, take care of yourself both physically and mentally. You’ll go through
many changes during your pregnancy and once your baby is born. Try to make time for
yourself most days to do the things you like to do, even if it’s just for a few minutes.
Living on a low income

If you’re living on a low income, contact the Alberta Adult Health Benefit program. You
may qualify for this benefit if you’re pregnant or have ongoing prescription medicine
needs. This benefit covers dental care, eyeglasses, ambulance services, diabetic supplies
and prescription medicine. To see if you qualify, call them toll-free at 1-877-469-5437 or
visit the Links section at healthyparentshealthychildren.ca/resources
You may also qualify for other resources and programs in your area. To learn more, call
Health Link at 811 or talk with your health care provider.
“ ”
I used the food bank and they referred me to the [pregnancy support program]
and I haven’t missed a day since I started going.
~ Mei, mom of two children
Healthy weight gain

Your body is changing to give your baby a healthy start. Gaining a healthy amount of
weight helps your baby develop and grow and lowers your risk of complications during
pregnancy and birth. Eating healthy foods and being physically active during pregnancy
will help you have a healthy weight gain.
How much weight gain is healthy?

Your health care provider will track your
weight gain as a part of your routine Calculate your BMI
checkups. The recommended amount of Pre-pregnancy weight (kg)
= Your BMI
weight gain during pregnancy depends on Height (m2)
your pre-pregnancy body mass index (BMI).
body mass index (BMI): a measure that is used to screen for health risk based on your height and weight

You can find out your pre-pregnancy BMI by doing one of the following:
■■ dividing your pre-pregnancy weight in kilograms (kg) by your height in metres (m),
divide the answer by your height in metres again
■■ asking your health care provider
■■ using the interactive pregnancy weight gain tracker. Visit the Tools section
at healthyparentshealthychildren.ca/resources
Gaining weight within the recommended guidelines supports you and your baby’s health.
You do not need to gain much in the first trimester, only 0.5–2 kg (1.1–4.4 lbs). Most of your
weight gain happens in your second and third trimesters. You may gain weight a little
faster or a little slower each week.
How much weight gain is healthy for you and your baby?
Pre-pregnancy Recommended total weight Average weekly weight gain rate
BMI gain for pregnancy in second and third trimesters*
less than 18.5 12.5–18 kg (28–40 lbs) 0.5kg/week (1.0 lbs/week)
18.5–24.9 11.5–16 kg (25–35 lbs) 0.4 kg/week (1.0 lbs/week)
25.0–29.9 7–11.5 kg (15–25 lbs) 0.3 kg/week (0.6 lbs/week)
30 and over 5–9 kg (11–20 lbs) 0.2 kg/week (0.5 lbs/week)
* These calculations assume a 0.5–2.0 kg (1.1–4.4 lbs) weight gain in the first trimester.
Reprinted with permission from the National Academy of Sciences, courtesy of the National Academies Press, Washington, DC.
Talk with your health care provider about getting the support you need throughout your
pregnancy if:
■■ the idea of how to manage healthy weight gain worries you
■■ you had a pre-pregnancy BMI of less than 18.5
■■ you had a pre-pregnancy BMI of more than 24.9
Remember, pregnancy is not the time to lose weight. Your health care provider can help
you set weight gain goals that are right for you. A healthy weight gain is better for you and
for your baby.
If you’re pregnant with twins, triplets or more, see page 37.

Weight gain tracker
If you’re interested in keeping track at home, you can track your weight gain using
this chart. To use an online pregnancy weight gain tracker, visit the Tools section at
Pre-pregnancy BMI:
Recommended total weight gain goal:
Pre-pregnancy weight:
Your pregnancy weight gain chart

Number of Your Weight Number of Your Weight
weeks Date weight gain* weeks Date weight gain*
First appt. weeks
weeks weeks
weeks weeks
weeks weeks
weeks weeks
weeks weeks
weeks weeks
weeks weeks
weeks weeks
weeks weeks
weeks weeks
weeks weeks
weeks weeks
* To find your weight gain, subtract what you weigh now from how much you weighed before you became pregnant. For
example, if you weighed 61.2 kg (135 lbs) before pregnancy, and weigh 63 kg (139 lbs) at 16 weeks, you’ve gained 1.8 kg (4 lbs).

Where does the
weight go?
With a pre-pregnancy BMI of 18.5–24.9, the
recommended weight gain is 11.5–16 kg (25–35 lbs)
Baby: 2.7–3.6 kg (6–8 lbs)

Breasts: 0.9–1.36 kg (2–3 lbs)
Blood: 1.8 kg (4 lbs)
Body fluids: 0.9–1.36 kg (2–3 lbs)
Protein and fat storage: 2.27–3.6 kg (5–8 lbs)
Uterus: 0.9–1.36 kg (2–3 lbs)
Placenta: 0.9–1.36 kg (2–3 lbs)
Amniotic fluid: 0.9–1.36 kg (2–3 lbs)
“ Just remember that the food

you’re eating right now is to help
you grow a whole person. It’s
developing their brain and their
body and everything…so put into
”
perspective what you’re eating and
why it’s important.
~ Wei, mom of a preschooler

The weight you gain matters
If you’re gaining too much or too little weight, talk with your health care provider. Women
who gain weight above the recommended range are more likely to have:
■■ more trouble giving birth
■■ a higher risk for caesarean birth (c-section), high
blood sugar (gestational diabetes) and high blood
pressure during pregnancy
■■ babies who are born preterm
■■ babies who are born large for their age or who have a
high birth weight of more than 4 kg (9 lbs)
■■ babies who will be above a healthy weight later in
childhood
■■ more trouble losing the weight after pregnancy
Women who gain weight below the recommended

range are more likely to have:
■■ babies who are born preterm
■■ babies who are born small for their age or who have a low birth weight
By gaining a healthy amount of weight during pregnancy, you can help give your baby a
healthy start in the first few weeks of life and beyond.
Eating during pregnancy

The foods you eat before and during pregnancy
help nourish you and your baby. Try to eat a Eating Well with
variety of healthy foods and follow Eating Well Canada’s Food Guide—
with Canada’s Food Guide (Canada’s Food Guide). First Nations, Inuit and Métis
The food guide is available
Skipping meals makes it hard for you and your in Plains Cree and other
baby to get all of the nutrients you both need. Indigenous languages.
Eating every 2–4 hours while you’re awake gives To learn more, visit
you and your growing baby a steady supply of the Links section at
nutrients. It may also help you feel better if you’re healthyparentshealthychildren.ca/
resources
feeling sick to your stomach (nauseated).
caesarean birth (c-section): when your baby is born with the help of an incision (cut) made into your abdomen and uterus
preterm: babies born before 37 weeks of pregnancy
low birth weight: babies born weighing less than 2.5 kg (5 lbs 8 oz)

To learn more about healthy eating, visit the Printables section at
Recommended
servings per day Examples of 1 serving Make each serving count
Vegetables and Fruit
14–18 years ■■ fresh, frozen and canned vegetables ■■ eat at least 1 dark green and
7 servings 125 ml (½ cup) 1 orange vegetable
■■ fresh, frozen or canned fruit ■■ choose vegetables and fruit
125 ml (½ cup) prepared with little or no
19–50 years ■■ leafy raw vegetables or salad added fat, sugar or salt
7–8 servings 250 ml (1 cup) ■■ no more than 125 ml (½ cup)
of 100% juice
Grain Products
14–18 years ■■ bread 1 slice (35 g) ■■ choose whole grains at least

6 servings ■■ rice or pasta 125 ml (½ cup) half of the time
■■ bannock 6 cm x 6 cm x 2 cm
■■ choose grains that are lower in
(2 ½ inches x 2 ½ inches x ¾ inch) fat, sugar or salt
19–50 years ■■ pita or tortilla wrap ½ small (35 g)
6–7 servings ■■ hot cereal 175 ml (¾ cup)
■■ cold flaked cereal 30 g, 250 ml (1 cup)
Milk and Alternatives
14–18 years ■■ milk or fortified soy beverage ■■ drink skim, 1%, or 2% milk or
3–4 servings 250 ml (1 cup) fortified soy beverage
■■ cheese 50 g (1 ½ oz)
19–50 years
■■ yogurt or kefir 175 g (¾ cup)
2 servings
Meat and Alternatives
14–18 years ■■ cooked fish, shellfish, poultry, lean ■■ have meat alternatives such as
2 servings meat, wild meat 75 g (2 ½ oz) or beans, lentils and tofu more
125 ml (½ cup) often
■■ 2 eggs ■■ eat at least 2 servings of fish
■■ cooked legumes, such as beans or every week
19–50 years lentils 175 ml (¾ cup) ■■ choose lean meat and
2 servings ■■ tofu 175 ml (¾ cup) alternatives prepared with
little or no added fat or salt
■■ peanut or nut butters 30 ml (2 Tbsp)
■■ shelled nuts and seeds 60 ml (¼ cup)

Track your servings
My Food Guide Servings Tracker can help you keep track of the amount and
type of food you eat while pregnant. To learn more, visit the Links section at
How much more food do I need to eat?

In the first trimester, you probably will not need any extra food servings beyond what
you normally eat. In your second and third trimesters, you’ll need a few more calories
to support the growth of your baby. An extra snack of 2–3 food guide servings per day
is often enough. Choose these extra servings from a variety of food groups. You’ll need
about 350 extra calories per day in the second trimester and about 450 extra calories per
day in the third trimester. Here are some examples:
350 calories 350 calories

Fruit parfait containing 175 g (3/4 cup) of One slice rye toast (35 g) with 2 large eggs
yogurt, with 30 ml (2 Tbsp) of chopped mixed with 15 ml (1 Tbsp) mayonnaise and
walnuts and 125 ml (1/2 cup) of sliced banana a medium orange
450 calories 450 calories

A small whole grain pita 28 g (1 oz) with Canned salmon 75 g (2 1/2 oz) with 15 ml
1/2 avocado, a medium tomato and 50 g (1 Tbsp) of mayonnaise on whole grain
(1 1/2 oz) of cheddar cheese crackers 24 g (0.8 oz) and 250 ml (1 cup) of
2% milk and a medium pear
If you’re carrying twins, triplets or more, see page 37.

“ ”
I’m eating normally, but more healthy.
~ Jolene, expectant mom
Important vitamins and minerals

Multivitamins with folic acid
Healthy eating and taking a daily multivitamin with folic acid in it are important during
pregnancy. If you’re not already taking a multivitamin, start now.
Read the label and take the recommended daily dose of the multivitamin. More than the
daily dose may give you too much of some vitamins and minerals. Check the label and
make sure your multivitamin contains:
■■ 0.4 mg (400 mcg) folic acid Remember to take your
■■ 16–20 mg iron multivitamin
Keep the bottle somewhere you can see
■■ 400 IU vitamin D
it, like by your toothbrush or your car keys
■■ vitamin B12
Some common prenatal vitamins contain 1 mg (1000 mcg) folic acid and 27 mg iron.
These doses are still considered safe during pregnancy.
A multivitamin that has 0.4 mg (400 mcg) of folic acid in it is enough for most women. Your
health care provider may tell you to take higher levels of folic acid if:
■■ you had a baby with a neural tube defect
■■ you or your partner have a close relative with a neural
tube defect
■■ you have diabetes
■■ you take anticonvulsant medicine
■■ you have a health condition such as Crohn’s or Celiac
disease, or you’ve had gastric bypass surgery
If taking your multivitamin makes you feel nauseated, try cutting your pill in half and taking
part in the morning and part at night. You can get a pill cutter from most pharmacies.
To use an interactive tool about folic acid, visit the Tools section at

Folic acid (folate)
Choose foods high in folate and take a multivitamin
with folic acid in it. This will help prevent serious
birth defects in the brain, skull or spine (neural tube
defects). Foods high in folate include:
■■ fortified grains like ready-to-eat cereals, breads
and pasta
■■ whole grains
■■ dark green vegetables like peas, spinach, brussels
sprouts and broccoli
■■ beans and lentils
■■ citrus fruits like oranges
Iron
Your body needs more iron to make more blood, as you need an extra 2 kg (4 lbs) of
blood during your pregnancy. Choose foods high in iron and take a multivitamin that has
16–20 mg of iron in it. Some women may need more iron than others.
Your body absorbs iron from meat, poultry, fish and shellfish better than iron from other
foods. The best sources of iron are beef, pork, wild game, chicken, lamb, fish, sardines,
shrimp, oysters and mussels. Other foods with iron are legumes, such as lentils, beans, and
chickpeas, tofu, whole grains and fortified grains such as fortified cereals or breads.
Eat foods with iron at the same time as you eat

foods with vitamin C. This helps your body absorb
more iron. Foods high in vitamin C include oranges,
strawberries, tomatoes, broccoli or bell peppers. You
could eat bean chili with tomatoes or an orange with
cereal and milk.
Iron supplements can sometimes make you constipated. Be sure to eat more fibre and
drink more fluids to help prevent this (see page 36).
Low iron (anemia) during pregnancy is linked to lower weight gain, and preterm and low
birth weight babies. A common sign of anemia is feeling tired. Since most women feel
tired during pregnancy, blood tests can help your health care provider know if you’re
getting enough iron.
constipation: stools that are hard, dry, difficult or painful to pass

If you eat healthy foods and take a multivitamin that contains iron every day, you should
get the amount of iron your body needs. Only take an extra iron supplement if your health
care provider tells you to.
Calcium
Calcium helps keep your bones strong. It also helps your muscles and nerves work
properly. During pregnancy, calcium helps your baby build strong bones and teeth. Drink
at least 500 ml (2 cups) of milk or fortified soy beverage each day.
Foods high in calcium are:

■■ milk and yogurt
■■ beverages labelled as ‘calcium fortified’ such as
soy or rice beverages
Other sources of calcium are:

■■ cheese
■■ canned salmon or sardines with bones
■■ tofu made with calcium
Vitamin D
Vitamin D helps to keep your bones strong. It also builds strong bones in your baby and
helps your baby store vitamin D for use during their first few months after birth. While
you’re pregnant:
■■ Follow Canada’s Food Guide. ■■ Take a multivitamin with 400 IU vitamin D
■■ Drink at least 500 ml (2 cups) of cow’s in it every day.
milk or fortified soy beverage every day. ■■ If you do not eat foods from Milk and
■■ Eat at least 2 servings of fish per week. Alternatives talk with your health care
provider about how to get enough
vitamin D.
Not all Milk and Alternatives are high in vitamin D. In Canada, milk and some yogurts have
vitamin D added to them. Foods that are high in vitamin D include:
■■ cow’s milk
■■ fortified soy beverages
■■ fish such as salmon, rainbow trout, herring, Atlantic mackerel and sardines
■■ vitamin D-fortified orange juice

Vitamin A
Vitamin A helps maintain normal vision, fights infections and supports your immune
system. It’s also important for your baby’s growth, including the development of their
heart, lungs, kidneys, eyes and bones.
If you’re taking a multivitamin with vitamin A, do not take more vitamin A supplements.
Too much vitamin A can cause birth defects. You’ll get enough vitamin A from your food
and multivitamin. Liver is very high in vitamin A. Do not eat more than 75 g (2 1/2 oz) of
cooked liver every 2 weeks.
Flaxseed
Omega-3 fats
You can eat ground flaxseed
Omega-3 fats help your baby’s eyes and and flaxseed oil once in a while
brain develop properly. Canada’s Food Guide when you’re pregnant—just not
recommends eating at least 2 servings of cooked every day. Not enough is known
fish and shellfish per week. Fish and shellfish that about its safety in pregnancy.
contain omega-3 fats are:
■■ anchovy, capelin, hake, herring, Atlantic mackerel, pollock (Boston bluefish), salmon
(farmed and wild), smelt, rainbow trout, shrimp, clams, mussels and oysters
Small amounts of omega-3 fats are found in:

■■ vegetable oils like canola oil, flaxseed oil,
walnut oil and soybean oil
■■ various nuts and seeds such as walnuts, soy
nuts, almonds, hemp hearts and chia seeds
■■ eggs enriched with omega-3 fats
Fluids and fibre

Fluids and fibre help prevent and manage constipation.
Your body needs about 2 1/2 L (10 cups) of fluid per day.
While this seems like a lot, it includes all types of drinks,
soups and the water in vegetables and fruits. You’ll need
more fluids when you’re physically active and in hot
weather. Here are some tips for choosing drinks:
■■ drink water throughout the day
■■ drink milk at meals
■■ limit fruit juice to 125 ml (½ cup) per day

Fibre can help you have regular bowel movements and lowers your risk of getting
hemorrhoids. Sources of fibre include:
■■ vegetables and fruit with the skin left on ■■ legumes, such as beans, chickpeas, lentils
■■ whole grains, such as bread, cereals, rice and peas
and pasta ■■ seeds and nuts

Early weight gain is important when pregnant with twins, triplets or more to lower the
risk of preterm birth and to increase the chance for your babies to be born at a healthy
weight. Your health care provider may recommend that you see a dietitian for nutrition
counselling. A dietitian will be able to help you monitor your pregnancy weight gain and
the calories you’re eating throughout your pregnancy.
If you’re pregnant with triplets or more, you’ll

need more food to support your growing Vitamins and minerals
babies. Talk with your health care provider about Talk with your health care provider
how much weight you need to gain and how about how to meet your vitamin
and mineral needs when pregnant
much extra food you’ll need. If you’re pregnant
with twins, triplets or more.
with twins, try for the following weight gain:
Healthy weight gain for a twin pregnancy

Pre-pregnancy BMI Total weight gain for a twin pregnancy
18.5–24.9 17–25 kg (37–54 lbs)
25.0–29.9 14–23 kg (31–50 lbs)
30 and over 11–19 kg (25–42 lbs)
Reprinted with permission from the National Academy of Sciences, courtesy of the National Academies Press, Washington, D.C.
Healthy eating
If you do not already follow Canada’s
Food Guide at home, you may want to
“ I’ve had a nutritionist help me
increase my calcium, vitamin
D and iron for developing two
”
make a change as a family. Set small babies. She also helped me with
goals together that work for you. how much I needed to eat.
~ Amanda, pregnant with twins
hemorrhoids: swollen veins in the anus and lower rectum

Washing your hands
Washing your hands often is the best way to stop spreading germs and to stay healthy.
Most germs that make people sick can be passed on to others by people touching each
other or by touching things that a sick person has touched like handles and doorknobs.
Everyone should follow these steps when washing their hands:

1. Use warm running water and plain soap—you do not need to use anti-bacterial soap.
2. Rub the insides and backs of both hands and between fingers until there are a lot
of soap bubbles. Continue for about 20 seconds or long enough to sing the ‘Happy
Birthday’ song twice.
3. Rinse hands under warm running water.
4. Dry hands with a clean towel.
Food safety
Food may carry germs that can make you sick. Your ability to fight off infections is
decreased when you’re pregnant. Food poisoning can also affect your unborn baby.
Handling, preparing and storing food properly can reduce the chance of getting sick from
food poisoning.
Keeping food safe

Here are some tips to keep your food safe:
■■ Wash your hands with warm water and ■■ Wash vegetables and fruits under cold,
plain soap before handling any food. running water.
■■ Wash your hands again after handling ■■ Refrigerate or freeze perishable food,
food such as raw meat, poultry and fish. prepared food and leftovers within
■■ Wash and sanitize any surface that’s in 2 hours.
contact with raw meat, poultry or fish. To ■■ Check the temperature in your
sanitize, you can use a solution of 2 ml refrigerator using a thermometer to
(½ tsp) of household bleach in 1 L (4 cups) make sure it’s at 4 °C (40 °F) or below.
of water. After sanitizing, change your ■■ Check the temperature of your deep
dishcloth and wash your hands. freezer or chest freezer to make sure it’s at
least -18 °C (0 °F).
To learn more about food safety and safe food handling at home, visit the Links section at

Food poisoning
Food poisoning (food-borne illness) is caused by eating foods that have harmful organisms
or metals in them like mercury. These harmful organisms can include bacteria, parasites
and viruses.
Cause What it can do

Campylobacter jejuni
■■ Bacteria sometimes found in uncooked ■■ Makes you very sick with symptoms such as
meats, poultry, raw milk or raw dairy products, diarrhea, cramping stomach pain and fever.
raw vegetables, shellfish and untreated
drinking water. Campylobacter jejuni can cause
an infection called campylobacteriosis.
E. coli (Escherichia coli)
■■ Bacteria sometimes found in certain foods, ■■ Makes you very sick with symptoms such as
especially undercooked ground beef. vomiting and bloody diarrhea.
■■ Can cause kidney failure.
Giardiasis
■■ A protozoa found in surface water or in food ■■ Makes you sick with symptoms such as
contaminated with surface water. diarrhea, stomach cramps and bloating.
■■ Common in children, especially in children
in diapers.
Listeria
■■ Bacteria sometimes found in soil, water, and ■■ Makes you very sick with symptoms such as
the stool of humans and animals. Listeria can fever, tiredness and muscle aches.
cause an infection called listeriosis. ■■ You can pass the infection to your baby.
■■ Has been found in uncooked meats, uncooked ■■ It may cause a miscarriage, stillbirth or your
or unwashed vegetables, unpasteurized milk baby may be born very sick.
and soft cheeses, and ready to eat foods such
as hot dogs, pâtés and deli meats.
■■ Pregnant women are about 20 times more
likely to get listeriosis than other healthy adults
if they eat contaminated food.
(continued on following page)
unpasteurized: not put through a heat process to destroy harmful bacteria

stillbirth: death of a fetus in utero after 20 weeks of pregnancy, usually closer to term

(continued from previous page)
Cause What it can do

Salmonella
■■ Bacteria sometimes found in foods such as ■■ Makes you very sick with symptoms such as
sprouts, raw chicken or unwashed vegetables stomach cramps and diarrhea.
or fruit.
Toxoplasma
■■ A parasite, sometimes found in foods such ■■ People who are infected may not feel sick.
as raw or undercooked meat, that causes Most people do not show any signs of
an infection called toxoplasmosis. For more being sick.
information, see page 80. ■■ If you do feel sick, you may have symptoms
such as fever, tiredness and muscle aches.
■■ Even with no symptoms, you can pass the
infection to your baby. It may cause a stillbirth
or your baby may be born very sick.
Mercury
■■ A metal found naturally in the environment. ■■ Can affect how your baby’s brain develops.
■■ You can be exposed to it in many ways, such as
eating certain types of fish.
■■ For more information about mercury, see
page 42.

Foods to avoid and safer alternatives
You can reduce your chances of getting food-borne illness by not eating certain foods
while pregnant. Here are some common foods and fluids to avoid and some safer
alternatives.
Vegetables and fruit

Avoid these foods Safer alternatives
Sprouts such as alfalfa, radish and mung bean ■■ Washed lettuce, cucumbers, spinach or
other vegetables.
Why? They may be contaminated with E. coli or
Salmonella, even after cooked.
Unwashed vegetables and fruits ■■ Washed vegetables and fruits.

Why? They may be contaminated with E. coli,
Salmonella or Toxoplasma.
Unpasteurized juices and ciders ■■ Choose pasteurized juices and ciders—

check the label for the word ‘pasteurized’.
Found at farmers’ markets, roadside stands, juice
bars or the produce section of some grocery ■■ Most juices sold in Canada are
stores. pasteurized, such as those found on
grocery store shelves and bottled types
Why? They may be contaminated with E. coli or that have tops that pop up when opened.
Salmonella.
■■ Home-squeezed juices are safe if the
vegetables and fruits are washed in cold,
running water.
Milk and cheese

Raw (unpasteurized) milk ■■ Choose pasteurized milk.

Milk that comes right from an animal and is ■■ All milk sold in grocery stores is pasteurized.
not pasteurized. It’s illegal to sell or give away.
Why? May be contaminated with
Campylobacter, Salmonella, E. coli, Listeria or
Toxoplasma.
Unpasteurized and pasteurized soft, semi- ■■ Hard cheeses made with pasteurized milk such
soft, blue-veined cheeses such as havarti, as Romano, Parmesan, cheddar, Swiss or colby.
Brie, Camembert, and Mexican-style cheeses ■■ Soft, semi-soft or blue-veined cheeses only
(e.g., queso fresco, queso blanco). if they are made with pasteurized milk
Why? They may be contaminated with and cooked well.
Campylobacter and Listeria. ■■ Cottage cheese, cream cheese and processed
cheese made from pasteurized milk.
pasteurized: put through a heat process that destroys harmful bacteria

Meat and eggs
Raw or undercooked meat, poultry and fish ■■ Cook meat, poultry and fish to a safe internal
such as sushi temperature using a probe thermometer:
Why? They may cause many types of food- ground beef 71 °C (160 °F)
borne illnesses. wild game (deer, elk, small game) 74 °C
(165 °F)
poultry 74 °C (165 °F)
fish 70 °C (158 °F)
Fresh or frozen tuna, canned white ■■ Anchovy, capelin, hake, herring, Atlantic
(Albacore) tuna, shark, swordfish, escolar, mackerel, pollock (Boston bluefish), salmon
marlin and orange roughy. (farmed and wild), smelt, rainbow trout,
shrimp, clam, mussel and oyster.
Some lake fish caught in Alberta.
■■ Canned ‘light’ tuna.
Why? They may be high in mercury.
To learn more about fish caught in Alberta, call
Alberta Environment and Sustainable Resource
Development toll-free at 1-877-944-0313
or, visit the Links and Printables section at
Unheated, pre-packaged cold cuts, deli ■■ Dried and salted deli meats such as salami and
meat, hot dogs or wieners pepperoni.
Why? They may be contaminated with ■■ Heat deli meats, deli sandwiches and hot dogs
Listeria. to steaming hot—at least 74 °C (165 °F).
Refrigerated meat spreads, such as pâté, ■■ Pâtés and meat spreads sold in cans or those
liverwurst or smoked and imitation fish that do not need to be refrigerated until after
and shellfish that are sold refrigerated they’re opened.
Why? They may be contaminated with ■■ Heat refrigerated meat spreads or smoked
Listeria. fish or shellfish until steaming hot—to at least
74 °C (165 °F).
Raw or undercooked (soft) eggs, including ■■ Cook egg dishes thoroughly to a safe internal
foods or sauces that contain raw or temperature or the yolk is firm.
undercooked eggs, such as some salad ■■ Eggs from the grocery store that are graded.
dressings, cookie dough or homemade
eggnog.
Ungraded eggs
Why? They may be contaminated with
Salmonella.
probe thermometer: a thermometer that has a metal stem to check internal temperature of foods

Other questions or concerns
Caffeine Energy drinks
Small amounts of caffeine during pregnancy and Energy drinks have a lot of
breastfeeding are fine for most people. Try to limit caffeine in them and should be
your caffeine intake to 300 mg per day or less. avoided during pregnancy and
when breastfeeding.
Caffeine is found in:
■■ coffee—about 150 mg of caffeine per ■■ cola and some other carbonated
250 ml (1 cup) beverages—about 23–40 mg of caffeine
■■ green and black tea—about 30–50 mg of per 250 ml (1 cup)
caffeine per 250 ml (1 cup) ■■ chocolate—about 3–50 mg of caffeine in
1 chocolate bar
Water
Public water supplies are safe to drink. If you use water from a private source
like a well, dugout or creek, have it tested for bacteria, fluoride, nitrates and
other chemicals before you use it. Routine water testing may not include a
test for lead or other metals, which could be of concern. If you have questions,
contact an environmental public health inspector. For more information and
to find an office near you, visit the Links section at
Herbs and herbal tea

Many herbal teas and herbs are not safe during pregnancy. If you drink herbal teas, choose
orange peel, ginger, peppermint leaf or rose hip. You can drink up to 750 ml (3 cups) a day.
To learn more, call the Medication & Herbal Advice Line toll-free at 1-800-332-1414.
Plant-based drinks
These may be lower in protein and may not be fortified with calcium and vitamin D. If you
drink plant-based drinks, like soy, hemp, coconut, rice or almond milk instead of cow’s milk,
choose one that’s fortified. Talk to your health care provider if you choose these drinks.
Alternative sweeteners
Aspartame, sucralose, acesulfame K, stevia and saccharin, are safe in small amounts during
pregnancy and breastfeeding. Do not use cyclamate, found in tabletop sweeteners such as
Sweet’n Low® and Sugar Twin®.
Restricted diet
If you do not eat certain foods or food groups, you may be missing important nutrients
you and your baby need. Talk with your health care provider if you do not eat certain foods
or food groups.

Allergies
During your pregnancy continue to avoid foods that you’re allergic to. You do not need to
stop eating any other foods during your pregnancy to prevent your baby from developing
allergies.
Trouble digesting milk-based foods (lactose intolerance)

You can buy lactose-reduced milk or fortified soy beverages in most grocery stores. You
can also buy lactase enzyme tablets, drops or chewables. If you have any questions, talk
with your health care provider.
Being physically active

Regular physical activity is safe and healthy unless you’re having complications with your
pregnancy and your health care provider has told you to change your activity level.
There are many ways to be active while

you’re pregnant, like walking, snowshoeing,
dancing, swimming, paddling, gardening
and other low-impact activity. If you were
physically active before you became
pregnant, you can probably keep doing
the same activities. If you weren’t regularly
active before your pregnancy, talk with your
health care provider before starting.
To find out what level of physical activity

is right for you this pregnancy, fill out
the first 2 sections of the PARmed-X for
Pregnancy (Physical Activity Readiness
Medical Examination) questionnaire. Take
it to your next appointment and talk
with your health care provider. To find the questionnaire, visit the Printables section at
“ At the beginning of my pregnancy, there were times when I didn’t want to

do anything! My neighbour tried to get me to go for walks with her and after,
”
I always felt better. Having someone to support me really helped because it
would have been harder to go on my own.
~ Jen, expectant mom

Benefits to staying physically active
Being active is important during your
Have fun and stay active
pregnancy. It also helps you during labour and
together. Doing physical activity
birth. When you’re not active for a long time, with your partner is a great way
you may feel more discomfort as your muscles to feel more connected.
tighten and your blood circulation and energy
drops. Being active can:
■■ make you stronger and more flexible ■■ improve your mood and self-confidence
■■ help you with some of the discomforts ■■ help you sleep
of pregnancy, like swelling, leg cramps, ■■ get your heart pumping and improve
shortness of breath, backaches, varicose blood flow to all areas of the body
veins and constipation
■■ support healthy weight gain
■■ give you more energy
■■ lower your risk of developing gestational
■■ help you reduce and cope with stress diabetes or help you manage your
■■ help with digestion blood sugar
Staying motivated
You may feel more motivated to stay active if you choose activities you enjoy and that fit
into your schedule. Here are some tips to help you stay motivated:
■■ Start small. Walk for 15 minutes. Over the coming months, slowly work up to walking
for 30 minutes. Try to do this 3–4 times per week.
■■ Listen to music or an audiobook. Remember to
stay alert if you’re using headphones outdoors.
■■ Join a class. Many fitness and community centres
offer classes designed for pregnant women. Ask the
fitness facility if they have membership assistance
programs like fee reductions or on-site child care,
if needed.
■■ Try something new. Think about hiking, swimming,
snowshoeing, dancing or prenatal yoga.
■■ Track your progress. Write down what you did, how
long you did it for and how you felt afterward.
Pregnancy is a very physical experience. As you move

through your pregnancy, your body will go through
many changes that may affect your energy level and
your ability to be physically active.

Physical activity tips
Listen to your body:
Time to be active
■■ Your body knows what’s best for you
Evenings can be a great time to walk
and your baby. with your partner, family, friends or
■■ If you feel tired or uncomfortable, lower neighbours. If it’s dark, remember to
the intensity of your physical activity. wear bright, reflective clothing or lights.
Stay cool:
■■ Try not to get overheated during physical activity.
■■ During the summer, try to get your physical activity in the early morning or in the
evening, when it’s cooler outside.
Be comfortable:
■■ Wear a good-fitting and supportive bra
to protect your back and breasts.
■■ Wear loose clothing that will breathe and
keep you from getting too hot.
■■ Wear comfortable, well-fitting shoes with
low heels, that match the activity you’re
doing.
■■ Carry a water bottle with you and drink
fluid before, during and after the activity.
■■ Wear a hat and sunglasses for protection
from the sun when you’re outdoors.
When you walk:

■■ Warm up with a 5–10 minute slow walk.
■■ Gently increase your pace for 5–10
minutes.
■■ Slow your pace for a 5–10 minute cool
down at the end. Use good posture.
Keep your head up and your shoulders
back and down.
■■ Breathe deeply and have fun!

If you’re not already physically active
■■ Slowly increase how often you’re active to 3–4 times per week in your second trimester.
■■ Do activities at a moderate-intensity level. This means that you can still have a
conversation during the activity.
■■ Slowly increase how long you do an activity in the second trimester from at least
15 minutes to no more than 30 minutes per session.
Low- to no-impact physical activities

Low- to no-impact activities are easier on the body, especially the joints. During a
low-impact activity, one foot is in contact with the ground or equipment at all times.
An example of a no-impact activity is swimming. Try:
■■ walking. Start small and build up. Try walking to, or from, your next errand. You can walk
throughout your pregnancy—even while you’re in labour.
■■ swimming, water aerobics, stationary cycling or low-impact exercise classes
■■ yoga, Pilates or resistance training. Some of these activities will need to be adapted to
make sure they are safe for you and your baby during pregnancy.
Make sure to talk with your health care provider, check with a qualified instructor and
always listen to your body.

Higher-risk activities
Higher-risk activities may put you or your baby at a greater risk of getting hurt. Some of
these activities include:
■■ ice hockey, outdoor cycling, downhill skiing or snowboarding, horseback riding,
gymnastics, ice skating, roller blading, climbing and scuba diving
■■ heavy lifting or standing for more than 4 hours, especially in the third trimester
■■ high-impact activities like running and jumping. These can put more stress on your
joints and ligaments, which may be weaker because of pregnancy.
Talk with your health care provider about changing from higher-risk to lower-impact
activities that are safer for you and your baby during your pregnancy.
Call Health Link at 811 or talk with your health care provider if you have any other concerns
with physical activity.

Pelvic floor
The pelvic floor is made up of muscles and ligaments. Your pelvic floor:
■■ supports your uterus, rectum, bladder and bowel
■■ helps control your bladder and bowel
■■ works with the muscles of your back and abdominal wall to support your back
■■ has an important role in sexual function and pleasure
Pregnancy and birth are the most common causes of weak pelvic floor muscles. Weak
pelvic floor muscles may lead to stress incontinence. Pelvic floor muscle exercises
can help.
The 3 openings that pass through the pelvic floor are the urethra, vagina and anus. The
area between the vagina and anus is called the perineum.
Urethra
Vagina
Perineum
Anus
You can feel your pelvic floor muscles by:

■■ stopping or slowing the flow of urine while you empty your bladder. This is just a test to
find where the muscles are and should not be done as an ongoing exercise when you’re
emptying your bladder. These muscles are towards the front of the pelvic floor.
■■ inserting two clean fingers into your vagina and feeling your muscles squeeze around
your fingers. These muscles are in the centre area of the pelvic floor.
■■ tightening the muscles around your anus as if stopping the passing of gas. These
muscles are towards the back of the pelvic floor.
pelvic floor: the muscles and ligaments that extend from back to front and side to side across the bottom of your pelvis.
They attach to your pubic bone in front, your sit bones on each side and to your tailbone at the back.
stress incontinence: is the involuntary loss of urine that can happen when you do things like cough, sneeze, laugh, lift
and exercise

Pelvic floor muscle exercises
Doing pelvic floor exercises will help to strengthen the muscles of the pelvic floor.
Practice using these muscles at the same time, or tighten those at the front, centre or back
separately. Start doing these exercises in a position that is easy for you to feel your pelvic
floor muscles.
As you tighten (contract) the pelvic floor muscles, avoid tightening your legs, buttocks or
abdomen. Try not to push down or hold your breath. Focus on the full relaxation of the
muscles after you tighten it. Pelvic floor muscles need to be able to contract and relax.
Techniques to exercise your pelvic floor:

■■ Slow and sustained. Squeeze then slowly pull up and in. Work up to holding for
10 seconds at a time. Repeat up to 10 times.
■■ Quick and short. Squeeze and lift as quickly as possible. Hold for 1 second, then release.
Repeat up to 10 times.
Practice these exercises regularly 3 times a day throughout your life. This will help the
pelvic floor muscles stay strong. It can take 6–8 weeks to notice stronger pelvic floor
muscles. If you’re not sure you’re using the right muscles, or have any concerns, talk with
your health care provider.
Healthy posture and back

Healthy posture will help your body stay strong as it changes throughout your pregnancy,
make you less short of breath, and help with digestion. It may also help relieve some of the
normal aches and pains that come with pregnancy.
As your baby grows, your body needs to adjust to carrying more weight in the front. Poor
posture may cause:
■■ an aching lower back
■■ rounded shoulders
■■ nerve pain in the legs and buttocks
Check your posture by watching yourself in windows and mirrors or asking someone to
check for you.

Standing
Stand straight. Imagine that there’s a string attached to
the top of your head and someone’s pulling up on it.
Keep your knees slightly bent when standing—locking
your knees can put more pressure on your lower back.
To improve your posture while standing:
■■ Wear shoes with low heels.
■■ Keep your chin level, not tucked or raised.
■■ Relax your shoulders, keeping them down and back.
■■ Keep your back in a slight ‘S’ curve, with a slightly
curved lower back.
■■ Tuck in your buttocks.
■■ Relax your knees.
■■ Keep your feet supporting your weight evenly, side
to side and front to back.
Standing for more than 3 hours without a break can

affect the blood flow to your baby. Here are some
things you can do if you need to stand for a long time:
■■ Use proper posture when standing.
■■ Shift your weight from leg to leg—rock back and
forth on your feet and move your feet in circles.
■■ Use a stool—put one foot on the stool, then switch
to the other.
■■ Take short breaks from standing every 2 hours.
■■ Wear comfortable shoes with low heels.
■■ Change your position as often as you can.
■■ Talk with your employer to see if your work can
be changed to sitting or to take walking breaks
as needed.

Sitting
Sit up straight. Imagine that there’s
a string attached to the top of your
head and someone’s pulling up on it.
To improve your posture while sitting:
■■ Sit on your sit bones and keep your
spine straight and tall.
■■ Rest your feet flat on the floor—
keep your legs uncrossed.
■■ Wear shoes with low heels.
Sitting for more than 4 hours without a break can reduce blood flow and increase the
swelling in your legs and feet. If you need to sit for a long time:
■■ Keep your legs uncrossed. ■■ Draw circles in the air with one foot and
■■ Take short breaks to stretch or walk then the other.
whenever possible. ■■ Use proper posture while sitting.
■■ Use a stool at your desk so you can ■■ Use a hard, straight-backed chair during
change the position of your feet. the later stages of pregnancy—it may be
■■ Use a rolled-up towel between the more comfortable and may be easier to
small of your back and your chair to help get out of rather than a low, padded chair.
relieve backaches.
Lifting
While lifting objects:
■■ Make sure your feet are on a
solid surface.
■■ Keep your back straight and your
feet apart.
■■ Bend your knees and keep your head up
while squatting down—do not bend Reproduced with permission from Healthy Spines (2017)
forward from the waist to pick things up.
■■ Hold objects close to you with your arms bent. Use your leg muscles to push yourself
back up—keep your back straight and your head up.
■■ Do not lift heavy objects above waist level.
■■ If changing direction, turn your whole body, do not just turn your upper body.

Caring for your teeth and mouth
Good mouth care habits are an important part of a
healthy pregnancy. For good oral health:
■■ Brush your teeth with fluoride toothpaste twice a day,
especially before bedtime.
■■ Floss once a day.
■■ If you use tobacco or tobacco-like products, try to
cut down and quit.
■■ Limit foods with sugar and starch to mealtimes whenever you can.
■■ Drink water throughout the day.
■■ Try not to sip on sweetened drinks like specialty coffees, sugar-sweetened drinks and
flavored water. Carbonated beverages like diet pop also have acid in them that can be
harmful to your teeth if sipped on all day.
Common conditions that affect the mouth during pregnancy are:

■■ pregnancy gingivitis: a gum disease that causes your gums to become red, swollen,
tender to touch and bleed easily. It can increase your risk of tooth decay, especially if you
do not brush your teeth and gums often. Changes in hormone levels during pregnancy
make gums more sensitive to plaque and bacteria. Tobacco or tobacco-like products
can also cause pregnancy gingivitis. Sometimes you can get a more serious form of
pregnancy gingivitis known as periodontal disease. If this happens, you may need to visit
your dental office more often during your pregnancy.
■■ tooth decay: bacteria in your mouth make acids from the sugars and starches you eat.
The acids attack the surface of the teeth for about 20 minutes after eating. Eating and
drinking foods that have sugar and starch in them throughout the day—even natural
sugar—increases the number of times the teeth are exposed to these acids. This can
increase your risk of developing tooth decay, and why you need to keep brushing
and flossing.
It’s safe to have dental care when you’re pregnant. Tell your dentist or dental hygienist that
you’re pregnant. They will work with you to create a dental care plan to help you prevent
pregnancy gingivitis and tooth decay, and to deal with any other dental concerns. They
may also suggest using products to fight bacteria and strengthen teeth. If you haven’t
been to a dentist or dental hygienist in the last year, or if you see changes in your mouth,
make an appointment during your first trimester.
plaque: a clear, sticky substance found on the tooth surface made by bacteria in the mouth. These bacteria produce
acids that can damage the teeth and gums.

Mental health
Pregnancy is a time of change both physically and mentally. During pregnancy, changes in
your hormone levels and physical changes to your body could affect your mental health.
Even if this is a planned pregnancy, you or your partner might have mixed feelings. You
may have times when you feel a lot of joy and excitement about meeting your baby, and
times when you may also feel sad and worried.
There can be many reasons for mental health changes for you and your partner like:
■■ changes in relationships with your partner, family and friends
■■ role changes in becoming a new parent
■■ leaving work for maternity leave/ If you’re a partner
parental leave Pregnancy is a time of change for you
too! You may feel excited, happy, sad or
■■ changes in lifestyle—including more
worried. Talk about how you’re feeling
financial pressures
with your partner, family or friends.
■■ feeling tired
■■ not getting enough sleep
“ I didn’t talk about my worries and fears, and it’s important to talk. It’s a
”
confusing and exciting time, and talking about it may lessen your fears and
help you to cope with anxieties and fears. Talk to someone about them.
~ Fatima, mom of a toddler

Healthy relationships
By taking care of yourself and taking care of your relationships you, your partner, and any
other support people are creating a safe and secure place for your new baby to come
home to. Take the time over these next months to think about the parents you want to be.
You’ve likely had many different kinds of relationships throughout your life. There are
relationships with family, friends, and co-workers as well as sexual or intimate relationships.
Healthy relationships can offer support and comfort and improve overall health and
well-being. Having a healthy relationship with your partner and others will help you feel
supported throughout your pregnancy.
Healthy sexuality
Healthy sexuality is part of a healthy relationship. Sexuality is the way people experience
and express themselves as sexual beings. You may go through changes during pregnancy
that can affect your emotions and sexuality. You may be concerned about:
■■ feeling tired, having nausea or sore breasts
■■ changing levels of sexual desire, like feeling
more or less desire. This can be related to your
energy and hormone changes, especially in
the second trimester.
■■ your body’s changing shape and size
Talking about your feelings with your partner

may help you to understand each other’s needs.
People show their sexual desire in many ways,

not just through sexual intercourse. Intimacy and
caring for one another also includes cuddling,
hugging, kissing and showing tenderness
towards each other.
Sexual intercourse is safe during pregnancy unless your health care provider recommends
you should not for medical reasons. Your baby is protected by the abdomen, the walls of
the uterus and is cushioned by amniotic fluid.
It’s normal to have Braxton-Hicks contractions during sexual activity, especially during
orgasm or when the nipples are stimulated.
Braxton-Hicks contractions: your uterus slowly tightens and then slowly releases—this is not labour, it’s your body
getting ready for labour

Safer sex
Practice safer sex, even when you’re pregnant. Safer sex is about protection from STIs
(Sexually Transmitted Infections). You can pass an STI such as chlamydia, gonorrhea,
hepatitis B, syphilis, genital warts, HPV (Human Papilloma Virus) or HIV (Human
Immunodeficiency Virus) to your baby during pregnancy and birth. STIs during pregnancy
may also cause miscarriage, premature birth, low birth weight and stillbirth. You’ll be offered
routine testing for STIs. Practicing safer sex will reduce your chance of getting an STI.
You’re practicing safer sex when neither you nor your partner are having a sexual
relationship with anyone else, you’ve both been tested for STIs and the tests show that
neither of you have an STI.
STIs can be spread by people who do not know they’re infected. Use a condom every time
during vaginal, anal and oral sex until you’re sure that neither you nor your partner have
an STI. The only certain way to prevent an STI is to have no sexual contact (abstinence),
including vaginal, anal or oral sex.
To learn more about safer sex call Health Link at 811, your health care provider, or to use an
interactive tool about STIs, visit the Tools section at
Understanding your relationship

When you think about your relationship with your partner or others, it might be helpful
to think about what makes a relationship healthy, unhealthy or abusive. Sometimes stress,
family changes or the responsibilities of having children can lead to conflict—and conflict
can sometimes lead to family violence.
Family violence happens when someone uses abusive behaviour to control or harm a
family member or someone they have a close relationship with. For some families, abusive
behaviour may have started before the pregnancy. Often, it begins or gets worse during
pregnancy or after birth.
If you’re not sure if your relationship is healthy, you can use the examples in the ‘Is my
relationship healthy?’ table, on the next page, as a guide. However, it’s also important to
trust your instincts. If something doesn’t feel right in your relationship—and you feel safe
to do so—think about making changes now. It’s normal for adults to disagree—but abuse
is never acceptable.
STI (Sexually Transmitted Infection): an infection passed on by sexual contact

genitals: sexual organs which include the male’s testicles and penis and the female’s vulva-labia, clitoris and vaginal
opening (the vagina is part of the female reproductive system and is inside the body)
HPV (Human Papilloma Virus): the virus that can cause genital warts. A few strains can lead to cancer.
HIV (Human Immunodeficiency Virus): the virus that causes AIDS

Is my relationship healthy?
Healthy Unhealthy Abusive
■■ You feel safe, ■■ One person feels ■■ One person feels afraid
Sharing feelings
comfortable and strong uncomfortable telling to tell the other how
enough to tell each the other how they really they really feel. They’re
other how you really feel. feel. scared of being rejected,
abandoned, getting
‘put down’ or being
threatened.
You listen to and respect One person ignores One person treats the
Communicating
■■ ■■ ■■
each other’s point of the other and doesn’t other with disrespect.
view. respect their opinions. ■■ One person ignores
■■ You make decisions the other’s ideas and
together. feelings or makes fun of
them.
■■ You have equal say in ■■ Disagreements often ■■ One person is afraid to

the relationship. turn into fights that disagree because they
■■ You show respect to include yelling, criticism do not want the other to
each other even when or harsh words. get angry or violent.
you have disagreements. The disagreement is
Disagreements
■■
■■ You work things out used as an excuse for

together, so you both abuse.
get what you need. ■■ One person controls the
money and prevents the
other from spending
money they’ve earned,
accessing bank accounts
or being part of financial
decisions.
■■ You’re honest about ■■ One person is ■■ One person ignores the

Intimacy and sex
how you feel about embarrassed to say how other’s needs and wants.
being physical and they feel or what they ■■ One person may be
having sex. need. pushed into doing
■■ Neither of you feels ■■ One person may go things that make them
pressured to do along with things feel uncomfortable,
anything you do not that they may not be afraid or ashamed.
want to do. comfortable with.

Is my relationship healthy?
Healthy Unhealthy Abusive
■■ You can spend time ■■ One person thinks there ■■ One person doesn’t
alone and think of this may be something let the other spend
as a healthy part of the wrong if the other wants time doing things on
relationship. to do things without their own because it’s
Time alone
them. seen as a threat to the

■■ One person tries to keep relationship.
the other to themselves. ■■ One person may
monitor the other
person’s activities and
isolate them from family
and friends.
■■ You value the differences ■■ There have been a ■■ There’s a pattern of

between each other few times when harsh increasing or ongoing
and work to be words are used, and verbal or psychological
Verbal
non-judgmental. one partner felt at risk abuse. This may include

■■ You both try hard not to of harm. damaging belongings,
talk harshly to or about ■■ There’s no clear pattern name calling, and threats
each other. of abuse. to hurt or kill you, a
family member or pet.
■■ There’s no physical ■■ There have been a few ■■ There’s an increasing

violence or threat times when one person or ongoing pattern
of violence in the felt at risk of harm. of pushing, slapping,
relationship. ■■ There’s no clear pattern shaking, choking,
punching or forced
Violence
■■ Neither partner feels of abuse or violence.

at risk of being hurt or sexual contact.
harmed.
■■ Both partners behave in
ways that keep the other
safe (safer sex practices,
financially responsible).

What is abuse?
Abuse is any behaviour used to control another person’s actions. Abuse can happen to
anyone, whether you’ve experienced abuse in the past or not. If you grew up with abuse,
this behaviour may seem normal to you. However, abuse puts the person being abused
and their baby’s health at risk. If the violence or threat of violence has happened once, it’s
very likely to happen again. It often gets worse over time, happens more and more often
and is more intense. It often develops into a cycle of abuse. Not all abuse fits this cycle.
Often, as time goes on, the ‘honeymoon phase’ disappears. If the image on this page
seems familiar to you, there is help available.
Cycle of Abuse
Tension building
■ minor incidents of physical/emotional abuse
■ victim feels growing tension
■ victim tries to control situation to avoid violence
■ ‘walking on egg shells’ victim cannot control abuser
■ longest phase
Minimizing the abuse or

acting as if it did not happen.
Denial keeps the cycle going.
Denial
Honeymoon Phase Perpetrators, victims, and Explosion

■ abuser sorry and apologetic
society at large minimize
The actual abuse is:
■ abuser makes promises
abuse in relationships. ■ physical
■ ‘hearts and flowers’ ■ sexual
■ idealized and romantic ■ emotional
■ this phase often disappears ■ verbal
with time ■ financial

It’s okay for adults to disagree, but nobody deserves to be abused or to see abuse. Many
people who are abused stay in a relationship to keep their home and family together.
However, children who see abuse are harmed by it. No one has the right to abuse another
person whether they are an adult or a child.
There are programs for families and partners who have experienced abuse and for those
who abuse. There’s help for everyone in the family.
If you’re experiencing abuse, talk with someone like a friend, family member, health care
provider or other support person. There are many ways you and your family can get help:
■■ If you’re in danger, call the police at 911.
■■ If you’re hurt or have health concerns, go to your health care provider, urgent care centre
or emergency department. Tell them how you got hurt.
■■ Call Health Link at 811 for your local emergency shelter—24/7, when it’s safe for you to
do so.
■■ Call the Family Violence Info Line toll-free at 310-1818, available 24/7 in more than
170 languages. You can also call this number to get information to help you understand
abuse, make a safety plan, access financial supports, and find information about a place
to stay, if you need one.
Visit the Links section at healthyparentshealthychildren.ca/resources to learn more

about abuse, staying safe and getting support:
■■ to find a lawyer from the Law Society of Alberta Lawyer Referral Service who will answer
your questions in confidence—the first consult is often at no cost to you
■■ from Legal Aid Alberta, call them toll-free at 1-866-845-3425 to find a lawyer to
represent you
■■ if you’re new to Canada and want to find out your rights, contact your local Citizenship
and Immigration Canada Office

Feeling stressed
Everyone has some amount of stress. Too much stress may affect your health or your
baby’s developing brain. When you’re stressed, your baby’s environment is under stress
too, which can impact their development. Learning ways to cope with stress will help you
during your pregnancy and support a healthy environment for your developing baby. It
will also build coping skills for the everyday stresses of parenting.
Some suggestions to help you cope with stress and changing emotions:
■■ Take time every day to relax, rest and ■■ Connect with your community.
get enough sleep—nap if you need to. ■■ Join a prenatal group.
■■ Be realistic about what you expect ■■ Connect with your spiritual self—talk
of yourself. with your spiritual advisor.
■■ Talk about your thoughts and feelings ■■ Do one special thing for yourself
with someone you trust, such as your each day.
partner, family, friends or health care
provider.
■■ Eat healthy foods and eat at regular times. Make time for you
■■ Drink plenty of fluids. Try to make time for yourself every
day, even if it’s just for a few minutes.
■■ Go for walks outside—fresh air can help
Write out a list of the things that help
you feel refreshed.
you relax—maybe a short walk with
■■ Ask for help from others. a friend, a bath, an afternoon nap or
reading a book. You might want to try
■■ Accept offers of support such as child
meditating, listening to music or going
care or meals. to a relaxation class.
■■ Spend time with a friend.
It may also help if you’re in contact with other people who are pregnant, as they may
understand what you’re going through. Prenatal classes, exercise classes, online communities
and similar social activities are good places to meet others who are pregnant—you can build
on that support by joining parenting programs after your baby is born.
“ One big thing was not being afraid to ask my husband for help getting things
done. I found asking my husband for a lot of help was really good.
”
~ Linda, expectant mom of twins

If you have stress that is not going away, there are supports that can help. You’ll find
information about online and in-person classes at your community or public health centre,
or at your community and recreation centre. You can also ask friends, family, your health
care provider or call Health Link at 811.
Breathing techniques to help you with stress relief

■■ Try breathing to the word ‘relax’. It has two syllables— ‘re’ and ‘lax’. As you breathe in
say ‘re’ to yourself. As you breathe out say ‘laaax’ to yourself. As you’re breathing in and
out, keep your mind focused on the word ‘relax’ and let go of any muscle or emotional
tension you feel in your body. Focus on the out-breath ‘laaax’ and your in-breath will
happen naturally.
■■ Try counted breathing. As you breathe in, count slowly to 3 or 4 or whatever number
is comfortable for you. As you breathe out, count to 3 or 4 again. You may find it’s
more comfortable to breathe in for a shorter count and out for a longer count (e.g., in
for 3 and out for 4), especially as you get further along in your pregnancy.
■■ Try breathing in through your nose and out through your mouth. Keep your mouth
very soft as you sigh the breath out. You may find it helpful to make a sound on the
breath out (e.g., ‘oooooh’ or ‘aaaaah’).
For some expectant parents

physical, social and emotional If you’re a partner
changes may lead to mental You need to take care of yourself too. Try to:
illness. While some people may ■■ eat well, get enough sleep and stay active
be at higher risk, mental illnesses
■■ find support from family, friends and others
can happen to anyone. Mental in the community
illness is just like any other
health or medical condition, You may go through many of the same
and there are many ways to symptoms, behaviours and feelings as your
successfully treat it. If you’re pregnant partner. You may also feel:
concerned about you, or your ■■ overwhelmed and afraid that you can’t meet
partner’s mental health, talk to your partner’s increased emotional needs
your health care provider. The ■■ left out or ignored
sooner you get help, the better ■■ a bit distant from the pregnancy
you or your partner will feel.
To find health services in your area, visit the Links section at


Be patient with yourself
and others and keep
your expectations
realistic. Try to maintain
healthy, open and
honest communication.
Remember, the best way
to take care of your baby
is for you and your partner
to take care of yourselves.
Things you can do together

Here are some things you can both do to cope with stress and changing emotions:
■■ Make some time for yourselves. ■■ Share the household tasks.
■■ Take a break for an afternoon or an ■■ Go to prenatal classes and talk with
evening to relieve the pressure. other expectant parents. They’re
■■ Go to ultrasound appointments and probably feeling many of the same
prenatal visits together. things you are.
Depression and anxiety

While it’s normal to feel many emotions in pregnancy, including feelings of excitement and
joy, you may also:
■■ feel sad ■■ have difficulties concentrating
■■ cry for no clear reason ■■ feel guilty or overwhelmed
■■ be impatient and irritable, sometimes for ■■ feel tired or have trouble sleeping
no clear reason ■■ have mood swings (e.g., joy to sadness,
■■ feel restless and anxious laughing to crying)
These are common feelings that may be caused by hormone changes during pregnancy. If
these feelings last for more than 2 weeks, are upsetting, or make it hard for you to do your
everyday activities, you may be depressed or have anxiety.

You may be worried about
talking to your partner or
someone about these feelings.
You may think that this is not
how you’re supposed to feel,
or it’s not what you expected.
You’re not alone. Talking about
these feelings and getting
help when you first notice the
symptoms of depression or
anxiety is important. Asking
for help doesn’t mean you’re
weak, or that you will not be
a good parent. The earlier
you ask for help, the sooner
you can get the support you
need and start feeling better. It’s also possible for
both you and your partner to have symptoms of Talk with your health
depression during pregnancy. care provider
If you or your partner have
Being pregnant can be an adjustment. There is a ever had depression, anxiety
lot of focus on taking care of your baby. Taking care or other mental health
of yourself, both mentally and physically, is one of concerns before or have these
the most important ways to take care of your baby. symptoms now, talk with your
Practicing these self-care tips may help improve health care provider.
your mental health during pregnancy:
■■ Nutrition: Eating regularly and following Canada’s Food Guide supports mental
well-being.
■■ Physical activity: Being active supports mental well-being and may help to reduce
stress.
■■ Sleep: Getting enough sleep can help you solve problems, manage your feelings and
cope better with change.
■■ Time for self: Practicing simple relaxation techniques such as deep breathing may help
to reduce stress (see page 62).
■■ Support: Be kind to yourself—it’s okay to accept and ask for help. Talk about how you’re
feeling with someone who can listen without judging and who can offer you support.

Symptoms of depression
Behaviours Thoughts
■■ not coping with things that you used ■■ “I’m a failure.”
to be able to handle ■■ “It’s my fault.”
■■ starting things and not finishing them ■■ “Nothing good ever happens to me.”
■■ avoiding places, people, family and ■■ “I’m worthless.”
friends
■■ “Life’s not worth living.”
■■ using alcohol or drugs to make you
feel better ■■ “People would be better off
without me.”
■■ not doing things you used to enjoy
■■ “I wish I were dead.”
■■ having trouble concentrating or
making decisions
Feelings Physical Symptoms

■■ overwhelmed or hopeless ■■ tired all the time, sluggish or lethargic
■■ useless or not good enough ■■ trouble sleeping—either too much or
■■ irritable, restless or agitated too little
■■ frustrated or miserable
■■ sick, run down or no energy
■■ unhappy or sad
■■ headaches or muscle pains
■■ empty or numb
■■ upset stomach
■■ frequent mood changes

■■ changes in appetite—eating more
or less
“ ”
I would talk to people and a couple of times I called the Distress Line—
they have people to listen to you.
~ Ashley, mom of two children

Symptoms of anxiety
Behaviours Thoughts
■■ having trouble sleeping ■■ feeling scattered or having trouble
■■ avoiding people, places or concentrating
responsibilities ■■ thinking about the worst
■■ using alcohol and drugs to make you ■■ easily distracted
feel better ■■ having problems remembering things
■■ starting things and not finishing them
■■ pacing, fidgeting, or being restless
■■ re-checking things often such as if the
house is locked

■■ tense, stressed or uptight ■■ tight or painful chest, feeling like your
■■ panicky, unsettled or irritable heart is pounding
■■ things do not seem real or they feel

■■ dizziness, sweating or shaking
strange ■■ nausea or upset stomach
■■ feeling that something bad is going ■■ body aches or tense muscles
to happen
Depression and anxiety may happen during your pregnancy or after your baby’s birth. For
information on postpartum depression, see page 247.
!
Call Health Link at 811 or your health care provider if you’re
concerned that you or your partner may have symptoms of
depression or anxiety.

Alcohol
Drinking alcohol can harm your baby. It’s safest not to
drink alcohol while you’re pregnant or thinking about
becoming pregnant. Alcohol affects every woman and
baby differently.
Alcohol passes through the mom’s placenta and to the

growing baby. A baby’s liver is not as developed as an
adult’s, so it cannot break down the alcohol as fast. This
means that a baby’s developing organs are exposed to
the effects of alcohol for a longer period of time.
Drinking alcohol can affect your baby at any stage

during pregnancy. Once your baby’s developing brain If you’re a partner
or other organs are damaged, they can’t be fixed. You can support a
Drinking during pregnancy can can increase the risk of: pregnant woman by
not drinking alcohol
■■ low birth weight during the pregnancy
■■ preterm birth and having nonalcoholic
options available at
■■ miscarriage parties or celebrations.
■■ stillbirth
■■ withdrawal symptoms for your baby at birth such as being shaky and irritable, having no
appetite, sleeping poorly, diarrhea, vomiting, breathing problems, seizures or problems
with sucking during feeding
■■ fetal alcohol spectrum disorder (FASD)
Babies with FASD have permanent brain damage of different degrees, physical
impairments and behavioural challenges. They can have some or all of these problems:
■■ disrupted brain development—which can affect how their brain develops and how
they learn and remember
■■ birth defects such as face and head deformities as well as heart, kidney, bone and
muscle defects
■■ hyperactivity
■■ slowed body growth
■■ trouble understanding the consequences of their actions

FASD has lifelong impacts on your baby. There’s no cure. Some effects of drinking alcohol
during pregnancy may not be seen until your baby is older, when they have problems
in school, with learning or behaviour. Being exposed to alcohol before birth, especially
through binge drinking, is linked to things like mental illness or anxiety in early adulthood,
even in adults who haven’t been diagnosed with FASD.
If you drink alcohol, it’s never too late to make healthy changes. If you’re in a relationship,
make healthy changes together and support each other. Ask for help if you have concerns
about your alcohol use or your partner’s alcohol use:
■■ Make a plan to cut down and quit.
■■ Talk with your health care provider.
■■ Call the Alberta Health Services Addiction Helpline toll-free 24/7 at 1-866-332-2322.
Tobacco and tobacco-like products

During pregnancy, the harmful chemicals in tobacco and in second- and third-hand smoke
can pass through the placenta to your baby. These harmful chemicals can cause a higher
risk of miscarriage, preterm labour or other problems during pregnancy. They can also
affect your baby’s growth and development before birth and lead to things like low birth
weight, cleft lip, cleft palate and heart defects. Babies and children are more likely to have
health problems, such as respiratory illnesses, ear infections, behavioural concerns and
learning disabilities like attention deficit hyperactivity disorder (ADHD). These chemicals
also greatly increase your baby’s risk of sudden infant death syndrome (SIDS).
The best way to protect your unborn baby

from being exposed to the harmful effects of Stress and quitting tobacco
nicotine and other chemicals is to keep your Stress caused by quitting tobacco
home, vehicle and workplace tobacco-free. can be managed and will not hurt
your unborn baby. Ask your health
care provider for help.
binge drinking: drinking a large amount of alcohol over a short period of time with the intention of becoming
intoxicated
sudden infant death syndrome (SIDS): a sudden and unexplained death of a seemingly healthy infant under
1 year of age during sleep
nicotine: a chemical compound that is colourless and poisonous found in tobacco products

Tobacco and tobacco-like products can affect your health and your baby’s health and
brain development:
■■ Tobacco smoke has about 7,000 different chemicals in it. Of these chemicals, at least
172 are toxic (poisonous). About 70 of them cause cancers like lung and breast cancer as
well as other illnesses such as heart and lung disease.
■■ Smokeless tobacco (moist snuff, dip or chew) and tobacco that’s used up the nose
(dry snuff or snus) has more than 4,000 chemicals in it. Of these chemicals, more than 30
cause cancer, including mouth and throat cancers. Snuff products have more nicotine
in them than cigarettes. The average cigarette has 8.4 mg of nicotine while the average
moist dip product has 14.5 mg of nicotine.
■■ Electronic cigarettes (e-cigarettes) are battery-powered vapourizers that use liquid
vapour to deliver mist into the body (vaping). The mist is often a mixture of chemicals
and sometimes contains nicotine. E-cigarettes contain at least 10 chemicals that are
linked to cancer and birth defects. E-cigarettes could put you at risk of nicotine addiction
and are not recommended as an aid to quitting tobacco. No government or agency
regulates e-cigarettes, so there are not any standards for making these products.
Second-hand smoke and vapour

Second-hand smoke is the smoke that’s exhaled or that comes from the burning end of
a tobacco product like a cigarette. It’s a serious health concern for females and children
during their reproductive years. Being exposed to second-hand smoke puts you at risk
for breast cancer, asthma and heart disease. For babies, being exposed to smoke from
tobacco before and after birth is also a major risk factor for SIDS and other health problems
such as respiratory illnesses and ear infections in childhood.
Second-hand vapour is the mist produced by e-cigarettes.

The mist that comes from an e-cigarette or vaping If you’re a partner
device has a mixture of chemicals that are toxic to you Keep your home and
and your family. Although the toxins are lower than with vehicle smoke-free. If
you’re using tobacco,
tobacco smoke, there are at least 10 chemicals that cause
try to cut down and
cancer, birth defects and harm to you and your partner’s
quit. If you’re not
reproductive system. ready to quit, smoke
or vape outside to
While most workplaces in Alberta have to be smoke-free, you
support the health
may still notice second-hand smoke at your workplace. You of your pregnant
may want to speak with your employer about making your partner and baby.
workplace 100% smoke-free.
reproductive system: all the parts of the male and female body that allow you to reproduce or have babies

Third-hand smoke
Third-hand smoke is the residue and gases that are left behind after a cigarette has been
used. They build up over time in vehicles and on surfaces such as upholstery, clothing,
draperies and carpets. Research is still needed to understand the impact of vaping related
to third-hand exposure.
Benefits of quitting
Quitting tobacco as soon as you can during pregnancy is healthier for you and your baby.
Quitting will improve your heart and lung health, which will be working extra hard during
your pregnancy. It will also improve your overall health right away and over time, reducing
your risk of cancer and other tobacco-related diseases.
If you quit smoking during pregnancy, your baby has a better chance of being born at a
healthy weight. A smaller baby does not mean an easier labour and birth. Smaller babies
are more likely to have health issues and may have to stay in the hospital longer. If you do
not think you can stop using tobacco all at once, try cutting down on the amount you use
in a day. Feel good about doing the best that you can.
If you quit using tobacco and are not exposed

to smoke in pregnancy, this will increase the Your lifestyle is important
amount of nutrients and oxygen your baby Pregnancy is an important period
gets during pregnancy. This will decrease your: of growth and development for
your baby. Your lifestyle can affect
■■ risk of miscarriage your baby’s physical and brain
■■ risk of preterm birth development. What you do matters.
When you do what you can to be
■■ risk of having a baby with a low birth weight healthy, you give you baby the best
■■ baby’s risk of SIDS chance for lifelong health.
■■ baby’s risk of birth defects like cleft lip and

heart defects
■■ baby’s risk of childhood and learning problems
It’s just as important to be tobacco-free after your baby is born. Quitting and staying
tobacco-free can reduce your child’s risk of respiratory illnesses such as chest colds, asthma
and ear infections.
Quitting tobacco
Quitting tobacco can be very challenging. Many people have to try many times, and you
may find that is also true for you. Each time you try, you’ll learn new things that will help
you for the next time. This may include learning what your triggers are. Just keep trying!

Quitting may take some time. Believe you can do it!
If you do not think you can stop tobacco all at once, Benefits of quitting
start by cutting back the amount you use every day. Quitting tobacco improves
your health right away and
When you’re getting ready to quit, think about reduces your risk of cancer
having your teeth cleaned to remove the stains over time. It also reduces
and products of using tobacco. This will help your your chances of getting other
gums heal—it may even help motivate you to stay disease caused by tobacco use.
tobacco-free.
During pregnancy, counselling is the recommended treatment for quitting tobacco. For
some women, the physical and emotional side-effects of quitting can be too hard to face
with counselling alone. If you need other products such as nicotine replacement therapy
(NRT) or other medicine, talk with your health care provider or pharmacist to be sure using
medicine is the safest, least harmful choice for you and your baby.
If anyone in your family uses tobacco or tobacco-like products, try to cut down and quit
together. If they are not ready to quit, ask them not to smoke or vape around you and
to smoke or vape outside. If they will not go outside, leave the room when they smoke
or vape. Talk with your health care provider for support to work towards clean air in your
home and vehicle. Try to work together to support one another to make healthy changes
together.
It may help you stay tobacco-free if you: If you want help to quit and stay
tobacco-free:
■■ Think about why it’s important for you
and your family’s health. ■■ Talk with your health care provider.
■■ Remember what you do not like about ■■ Call the AlbertaQuits helpline toll-free
using tobacco. at 1-866-710-QUIT (7848) to talk with
■■ Know who you can count on for support. trained counsellors.
■■ Try to limit your time with people or

■■ Find a support person.
places that make you want to use ■■ Go to a tobacco cessation group, like
tobacco. QuitCore, in your area.
■■ Find healthier ways of coping with stress.
■■ Think about the financial benefits of not
smoking.
To learn more about how to quit and stay tobacco-free, the benefits
of quitting, and how to keep your home and vehicle smoke-free, visit
albertaquits.ca

Medicine, supplements and herbal products
Talk with your health care provider about any
medicine, vitamin and mineral supplements or Never assume it’s safe
herbal products that you’re taking, or planning Talk with your health care provider
to take. These products can affect your health before taking any medicine, vitamin
and the health of your baby as they can pass and mineral supplements or herbal
through the placenta to your developing baby. products. Never take a prescription
Some medicine, supplements and herbal medicine that is not yours.
products can cause birth defects.
Bring a list of all the medicine, supplements, or herbal products that you’re taking when
you visit your health care provider. Ask your health care provider if you still need all of the
items on your list. Your health care provider can discuss with you the safety of the products
you’re taking and provide recommendations. Take medicine as prescribed. If your health
care provider recommends any non-prescription medicine, take only what you need in
the smallest amount possible. To learn more about how to create a Medlist, visit the Links
section at healthyparentshealthychildren.ca/resources
Prescription and over-the-counter medicine

Prescription and over-the-counter medicine, like pain relievers and antacids, can also affect
your baby’s health if you take them while you’re pregnant. As soon as you think you might
be pregnant, talk with your health care provider about any prescription and over-the-
counter medicine you take, or plan to take, and ask about possible side-effects. They can
tell you whether it’s safe to keep taking the medicine or may suggest a safer one.
Some prescription medicines that cause birth defects are:

■■ Accutane® (acne medicine)
Before you stop
■■ Warfarin and Coumadin® (blood thinners)
Talk with your health care
■■ Valproic Acid (seizure medicine) provider before stopping
any prescription medicine.
To protect your baby:
■■ Tell all your health care providers that you’re pregnant.
■■ Do not take any over-the-counter medicine until you talk with your health care provider
or pharmacist.
■■ Read the label and follow the directions carefully.
■■ Pay attention to your body when you take any medicine and talk with your health care
provider if you have any side-effects.

There are many ways to help with common pregnancy discomforts such as headaches,
backaches, constipation, diarrhea, heartburn, nausea and vomiting (see page 96).
Sometimes the benefit of taking a prescription medicine outweighs the risks to the
developing baby. For example, if you’re taking a prescription medicine for high blood
pressure, epilepsy or depression, your health care provider will talk with you about why
it’s important to continue taking this prescription medicine during your pregnancy—or
change to another one.
Herbal products and other natural remedies

Herbal products and other natural remedies are chemicals that can act like medicine in
your body. Some can interact with each other and produce harmful effects when taken
together. Talk with your health care provider or pharmacist before you take any herbal
products, traditional medicine or natural remedies. Some may not be safe to take while
you’re pregnant.
Herbal and natural remedies are readily available at stores and even farmer’s markets. If you
choose to use them, buy them from a regulated Canadian producer.
To learn more, call the Medication & Herbal Advice Line toll-free at 1-800-332-1414, or visit
Links at healthyparentshealthychildren.ca/resources
Cannabis
Pregnant women should not use cannabis (marijuana, hashish, hash oil). You and your
baby’s health can be affected by using any type of cannabis. The dried flowers, leaves,
stems and seeds of cannabis are called marijuana, weed, pot and other names. Hashish
and hash oil also come from the cannabis plant. The cannabis plant contains more than
400 chemicals. Tetrahydrocannabinol (THC) is the main active chemical in the cannabis
plant that gives people who use it a ‘high’. THC affects areas of the brain that control
memory, concentration, and coordination. Cannabidiol (CBD) is an active chemical in
the cannabis plant that’s used for medicinal purposes. The levels of THC and CBD vary
depending on the plant strain used. Some forms of cannabis can have very high levels of
THC. Using cannabis may also cause other side-effects. It can:
■■ impair your short-term memory ■■ increase anxiety or paranoid thoughts
■■ cause you to make poor decisions ■■ increase your heart rate
■■ affect your coordination
heartburn: a burning sensation in the chest, caused by reflux

During pregnancy, the placenta and umbilical cord connect you and your baby. The
chemicals in cannabis can pass through the placenta to your developing baby and may
affect their health and development.
Developing babies exposed to cannabis are at higher risk for low birth weight. After they’re
born they might not be able to self-soothe and may have problems with sleep. There may
also be long-term effects such as:
■■ abnormal brain development
■■ slower growth
■■ learning disabilities and behaviour concerns
Until more is known about the short- and long-term effects of cannabis on babies and
children, it’s safest to avoid using cannabis while pregnant. Talk with your health care
provider for information on cutting down and quitting if you’re using cannabis. If you use
cannabis for medical reasons, talk with your health care provider about finding a safer
alternative while pregnant.
To learn more about cannabis, visit the Links section at

Other drugs
Pregnant women should not use other drugs. Just as with cannabis, drugs can pass
through the placenta to your developing baby and may affect their health and
development. Developing babies who’ve been exposed to other drugs such as fentanyl,
ecstasy, methamphetamines, cocaine, and heroin are at risk for problems like:
■■ birth defects
■■ the placenta separating from the uterus before birth
■■ preterm birth
■■ low birth weight
After these babies are born, there can also be long-term effects for them such as:
■■ abnormal brain development
■■ slower growth
■■ learning disabilities and behaviour concerns

These drugs can also affect how you think and make decisions, putting both you and your
baby at risk. There may also be an increased risk for overdose and unsafe situations that
can lead to physical injury and harm.
To learn more about cannabis and other drugs, and cutting back and quitting,
call the Addiction Helpline available 24/7 toll-free at 1-866-332-2322, or visit
the Links section at healthyparentshealthychildren.ca/resources
Being Safe
Infectious diseases
Infectious diseases can put both you and your baby at risk. They can be spread from one
person to another directly or indirectly from the environment. If you work with children or
in a health care setting, you’re more likely to be exposed to childhood illnesses and other
infectious diseases.
You can lower your risk of infectious disease by:

■■ keeping your immunizations up-to-date ■■ asking friends and family not to visit if
■■ washing your hands carefully and often they are not feeling well
■■ making sure your food is fully cooked

■■ seeing your health care provider if
and refrigerated you think you’ve been in contact with
someone who has an infectious disease
■■ taking precautions before you travel such as chicken pox, shingles, German
to help prevent illness or disease (see measles, fifth disease (parvovirus or
page 77) slapped cheek disease), cytomegalovirus
or tuberculosis
Immunization
During pregnancy, some vaccines are
routinely recommended. For example, the Immunizations protect
influenza vaccine is recommended when against diseases
you’re pregnant. Other immunizations may be Being immunized is much safer
recommended depending on your health and than getting the disease it prevents.
the level of risk to you and your baby.
immunization: the process by which a person is given a vaccine that will tell their body to develop antibodies to
protect against the disease
vaccine: a small amount of a weakened live or killed virus or bacteria given to you during an immunization. It makes
your immune system develop antibodies to protect you against a certain disease.

Live vaccines such as measles, mumps
and rubella (MMR) and varicella (chicken If you’re a partner
pox) are not routinely given during Keep your immunizations up-to-date.
pregnancy. It’s recommended that you Vaccine-preventable diseases still exist.
receive these vaccines after you have Some of these diseases are happening
more often now because some people
your baby. If other vaccines are needed,
are choosing not to get themselves and
your health care provider will discuss the
their children immunized.
risks and benefits to you and your baby.
Rubeola (red measles), mumps and
Some vaccines protect for life, while pertussis (whooping cough) are a
others need to be repeated (boosted) few examples of vaccine-preventable
diseases making a comeback. Many
after a certain time. If you or your family
of these diseases have no treatment
haven’t had all of your immunizations,
or cure and could lead to a life-long
or haven’t had your immunizations on disability and even death.
schedule, talk with your health care
provider about catching up.
To learn more about immunizations, visit the Links section at

Influenza immunization
Immunization with the influenza vaccine will protect you and your baby while you’re
pregnant. You can get immunized any time during your pregnancy. The protection you
get from the vaccine may transfer across the placenta and stay with your baby for a short
time after birth. If your partner and other family members get immunized, this also helps
to protect your baby after birth.
Being immunized against influenza ‘flu’ is recommended for all pregnant women and their
families because pregnant women are at higher risk of developing complications from
influenza. If you become infected with influenza while pregnant, you have a higher risk of
hospitalization, premature birth, and many other complications. Immunization protects
both mothers and their babies against influenza.
To learn more about influenza immunizations, visit the Links section at


Travel
Take a pass on pre-tanning
Traveling while pregnant
takes some planning. Help Indoor tanning is not recommended for anyone, before
travel or any other time, as it can cause skin cancer and
lower your stress and make
other effects. Protect your skin with sunscreen when you
your trip more enjoyable
are outdoors—both at home and when you travel.
by planning ahead.
If you’re planning on travelling out of the country, know the risks that can affect you
and your baby. Other countries may have different standards of safety, sanitation and
healthcare than what we have in Canada. There may not be safe food or clean water.
Look for travel advisories related to personal safety or mosquito-borne infections like
malaria, Zika virus or yellow fever. You may need to delay your travel or take steps to
protect yourself.
Here are some things to think about to protect yourself before, during and after your trip:
■■ Make sure your insurance provider knows you’re pregnant. Many insurance plans do not
cover pregnant women who travel or their baby if they give birth while away.
■■ Check the medical care and facilities that are available where you’re going.
■■ Make an appointment with your health care provider far in advance of your trip so that:
if you take prescription medicine, you can make sure you have the supply that
you need
you have the medicine you need to prevent
malaria, gastrointestinal and other illnesses
you receive any immunizations needed
against hepatitis, typhoid and other illnesses
■■ Take any other actions or precautions you
need to help prevent illness or disease, like
protection from mosquito bites.
When travelling on longer trips or by air:

■■ Drink lots of fluids.
■■ Try not to sit for too long—take breaks and
do leg exercises every hour to prevent blood
clots in your legs.
■■ Check with the airline for their rules about
flying during pregnancy.
blood clot: blood that has changed from a liquid to a gel-like clump

Mosquito-borne infections
When pregnant, avoid travelling to areas where there are travel advisories for mosquito-
borne infections, like malaria and Zika viruses. Malaria and Zika viruses can be spread to
people by mosquito bites. If you do need to travel to these areas, protect yourself from
mosquito bites by using netting, wearing long sleeves and pants, using insect repellent on
exposed skin and thinking about where you’ll stay ahead of time.
Pregnant women are more likely to be bitten by mosquitoes. This is because their body
temperature is a bit higher and they tend to get up at night to use the bathroom−leaving
the safety of the bed net.
Malaria
Malaria is very dangerous in pregnancy. It increases the risk of death for the mom and
increases the risk of miscarriage and stillbirth. Some medicines to prevent malaria are not
safe for pregnant women to take.
Zika
There is no vaccine to prevent Zika virus or medicine to treat the Zika virus infection. The
Zika virus can be:
■■ spread from an infected pregnant woman to the unborn baby
■■ passed from an infected male partner to a woman during sex. Zika virus can stay in
semen for up to 6 months.
An infection with the Zika virus during pregnancy can affect the brain and nervous system
of a developing baby. This can result in things such as:
■■ a brain that is not fully developed
■■ hearing loss
If your partner is pregnant
■■ eyes that do not develop normally and you have travelled to an
■■ arms or legs that do not develop normally area with mosquito-spread
Zika virus, for the rest of the
If your male partner has travelled to an area with a pregnancy you should:
Zika virus advisory, for the rest of your pregnancy: ■■ use condoms correctly
and consistently, or
■■ use condoms correctly and consistently, or
■■ avoid having sex
■■ avoid having sex
This will ensure that the Zika virus is out of his body
and not transmitted to you and your baby.

Talk with your health care provider if:
■■ you became pregnant within two months of travelling to a Zika risk area
■■ you’re pregnant and had unprotected sexual contact with someone who’s
been diagnosed with Zika virus infection
Help lower your stress and make your trip more enjoyable by planning ahead—
contact a travel clinic, your health care provider or call Health Link at 811 before
you travel.
To learn more about travelling during pregnancy or to find travel health services,
visit the Links section at healthyparentshealthychildren.ca/resources
Safe driving
The best way to protect you and your unborn baby Driving
is to wear a seat belt throughout your pregnancy. If If possible, try not to be the
worn properly, a seat belt will not harm your baby. driver during the third trimester.
■■ Wear the lap belt low and snug, under your baby
and your abdomen. It should lie over the upper
thighs or across the hips and pelvis, never over
the abdomen.
■■ The shoulder belt should cross the centre of the
chest and shoulder and fit snug. Never tuck the
shoulder belt under your arm.
■■ In cold weather, do not fasten the seat belt over
several layers of clothing, as this may cause the
lap belt to ride up. Instead, warm up the vehicle
first, unbutton your outer clothing and pull
the lap belt snug over as few layers of clothing
as possible.
■■ Slide the seat back as far as possible from the
steering wheel, dashboard and airbag.
If you’re in a motor vehicle collision and an

Not just cars ambulance is called, you’ll be transported
If you drive a motorcycle, ATV, to the hospital for assessment, either to the
snowmobile, lawnmower, farm or
emergency department or to the labour and
construction equipment, talk to your
birth unit. If an ambulance is not called, call
health care provider about using
these while pregnant. your health care provider for advice.

Hot tubs, saunas and hot baths
A hot tub, sauna or hot bath can cause you and your baby to get too hot, which could
affect your baby’s development. The hot tub, sauna or bath should not be so hot that
you’re uncomfortable. You can prevent you and your baby from getting too hot by:
■■ lowering the temperature to 38.9 °C (102 °F) or below
■■ limiting how long you sit in the bath, hot tub or sauna. Stay in a sauna for no more than
15 minutes and in a hot tub for no more than 10 minutes.
■■ keeping the water level below your shoulders in the hot tub
■■ making sure someone is with you in case you feel dizzy or faint
Pets and animals

Some pets and animals can carry
infectious diseases like Toxoplasma. You
can reduce your risk of getting sick by:
■■ washing your hands well after touch-
ing or handling any pet or animal,
especially before you eat
■■ not feeding raw meat to your pet
■■ wearing gloves when you garden so
that you do not touch pet or animal
stool—and washing your hands well
after gardening
■■ having someone else scoop the cat
litter box every day—make sure they
wash their hands well afterward
■■ having someone else clean the litter
Help protect against toxoplasmosis
box regularly using boiling water to by emptying and regularly cleaning
help decrease the germs the litter box. It’s best if your pregnant
partner does not take on this task
while pregnant.

Working while pregnant
Working during a healthy pregnancy is usually safe. However, some jobs may have some
risks and unhealthy demands. If you work long hours, take time to stretch if you’ve been
sitting and time to rest if you’ve been standing. Try to take a short break every 2 hours
while you work. Ask your supervisor if you can take extra breaks.
If you have a physically demanding job, take special care to protect yourself and your baby.
Here are some things to think about if your job is physically demanding:
■■ heavy lifting—if possible, do not lift more than 23 kg (50 lbs)
■■ repetitive lifting—if possible do not do a lot of lifting of anything more than 11 kg
(24 lbs) once you’re 24 weeks pregnant and beyond
■■ try not to crouch or bend
If you do a lot of lifting (see page 52), bending or climbing at work, talk with your health
care provider about safe limits.
Work camps
If you work in a remote
area like a work camp,
talk to your employer
about services and other
supports that might be
available to you.
Shift work
Some studies suggest that women who work rotating shifts and long hours may be at a
higher risk for preterm labour, having a low birth weight baby, or miscarriage. The risk goes
up if shift work and long hours are combined with other things like standing too long or
working in a very noisy place.
If you need to do shift work, ask your supervisor if your shifts can be rotated forward—
moving from morning shifts to afternoons to nights. This is less tiring than rotating
backward—moving from nights to afternoons to mornings. You can also ask if it’s possible
to work only day shifts while you’re pregnant.

High noise levels
Noise levels over 90 decibels, like lawnmowers and some machinery, may be linked to
babies born with low birth weights—especially when combined with other things like
standing too long. If your workplace is noisy, talk with your health care provider, supervisor,
or your human resources representative.
Pregnancy discrimination at work

Pregnancy discrimination is when you’re treated differently because you’re pregnant. The
law protects you from this. You can’t be fired, demoted, put on forced leave or excluded
from any work opportunities like contracts, trips or conferences because you’re pregnant.
You also have the right to return to your former position, or one that’s equal to it, after
maternity or parental leave. If you have concerns about your workplace, there are many
ways to get help:
■■ Talk with your supervisor and human resources representative about your concern.
■■ Offer some possible solutions and ask for other ideas.
■■ Be flexible and work with your employer to find a solution.
■■ If needed, get a note from your health care provider to make changes to your work
environment or duties.
If you have concerns about pregnancy discrimination and haven’t been able to solve them
by speaking to your supervisor and human resources representative, contact the Alberta
Human Rights and Citizenship Commission office confidential inquiry lines:
■■ Edmonton 780-427-7661
■■ Calgary 403-297-6571
■■ outside of Edmonton and Calgary call the Alberta toll-free number at 310-0000, then
call the number for the Edmonton or Calgary office
■■ TTY services if you’re deaf or hard of hearing, call them toll-free within Alberta at
1-800-232-7215
Other people who may be able to help you are:

■■ your Occupational Health and Safety representative
■■ Alberta Occupational Health and Safety, call them toll-free at 1-866-415-8690 or, visit

Chemicals and hazardous substances
Some chemicals and substances such as pesticides or paint can increase your risk of
miscarriage or having a baby with a birth defect. If you use or work around chemicals or
hazardous substances:
■■ Find out about the chemicals or ■■ Ask your supervisor if you can do
substances you may be exposed to. alternative work while you’re pregnant
■■ Wear the recommended protective that doesn’t expose you to dangerous
clothing, like gloves and masks. chemicals.
■■ Work in a well-ventilated area.

■■ Check the WHMIS (Workplace Hazardous
Materials Information System) data
■■ Follow the recommended guidelines in sheets at your workplace and talk with
your workplace. your Occupational Health and Safety
■■ Stay away from any chemicals that you do representative.
not need to be exposed to.
Read the labels on your household cleaners and follow On the farm and
the instructions for using, storing and disposing of them. in the garden
If the label says to use the cleaner in a well-ventilated area,
Read the label on any
make sure to open the window while you use the cleaner. fertilizers, pesticides,
herbicides, chemicals or
Do not use pesticides, lead-based paints, or paint
other products you may
removers while you’re pregnant. Weed and insect sprays be using.
have been known to cause miscarriage and birth defects.
Chemicals that can harm your baby get into the air when lead-based paints, varnishes
and paint removers are drying. It’s okay to use latex paint if you clean up afterwards with
water—not with paint remover.
Avoid being exposed to radiation while pregnant. Alberta’s safety regulations are very
high and protect pregnant women who work in areas where radiation is used. Follow all
workplace radiation guidelines. Do not touch anyone who’s being treated with radioactive
isotopes. Do not hold people or animals when they’re having an x-ray.
If you’re not sure a product is safe or to learn more about poison and drug information, call
the Poison and Drug Information Service (PADIS) toll-free at 1-800-332-1414.

Lead
Lead is a chemical found naturally in the environment. For pregnant women and young
children, lead should be avoided because it can cause serious health problems.
Here are some simple things you can do to prevent being exposed to lead:
■■ Run the tap before using water that hasn’t been
run for a few hours—especially if you live in an Lead
older home. Be careful when buying
■■ Use cold tap water for drinking and cooking— jewellery and toys made in
countries outside of Canada or
it has less lead than hot tap water.
the United States—they may
■■ Older homes may have lead-based paint, so have lead in them. Check all
make sure to follow the proper procedures manufacturers’ labels for lead.
when doing renovations. If you’re not sure about the lead
content, do not buy or use it.
■■ Dust, vacuum and wet-mop your house
regularly to help keep down the levels of dust
that may contain lead.
■■ If family members work or do hobbies with lead, such as stained glass, make sure they
shower and change their clothes when they’re done. This will help reduce the amount
of lead on their body.
■■ Do not store food or liquids in food containers like crystal glass or glazed and ceramic
dishes as they may have lead in them.
To learn more about reducing your exposure to lead, visit the Links section at

Planning Ahead
What is recommended?
Breastfeeding your baby
Feeding your baby exclusively for the first 6 months

with continued breastfeeding
Deciding how you’ll feed your baby is a personal up to 2 years of age and beyond
choice that depends on many things including is recommended.
your beliefs. It also depends on support from your
partner, family, friends, and health care providers. Your feeding decision may also change
depending on your needs and your baby’s needs at different stages.
Learn about your options and ask questions. You may

decide to breastfeed or feed your baby infant formula, or
both. Talk about it with your partner, support person and
health care provider. Whatever your questions or feeding
decision, there is information and support available now
and after your baby is born. Attending prenatal classes or
a breastfeeding support group while you’re pregnant will
give you more information and will help to answer your
questions.
There are many things to consider when deciding to breastfeed, formula feed or both.
Even if you’re not planning on exclusively breastfeeding your baby, you may choose to
breastfeed or hand express colostrum so your baby can receive its protective benefits.
Colostrum has antibodies, and gives your baby protection against infections and diseases.
For more information about breastfeeding,

see page 273. Information on formula Vitamin D for all babies
feeding can be found in the book Healthy All babies whether they are exclusively
Parents, Healthy Children: The Early Years or breastfed, partially breastfed or given
visit healthyparentshealthychildren.ca infant formula need 400 IU of a liquid
vitamin D supplement every day.
Choosing how to feed your baby is your Vitamin D helps your baby’s body
decision. If you decide not to breastfeed, absorb calcium and develop healthy
feeding with infant formula can also provide bones. It also prevents rickets.
good nutrition for your baby.
exclusively breastfeeding: no water, food or liquid other than breastmilk is given to your baby from birth. Your baby
can still be given vitamins, minerals and medicine.
colostrum: a high calorie, thick, yellow breastmilk that’s produced during the first few days after birth
infant formula: in this resource, infant formula refers to commercial, store-bought infant formula that is bought in
Canada
rickets: a disorder caused by a lack of vitamin D, calcium or phosphorus, which can lead to soft and weak bones

Things to think about when deciding how to feed your baby
Do you want to breastfeed? With the right teaching and support, most women who
want to breastfeed are able to do so.
Do you know someone who can teach you about breastfeeding? Breastfeeding can
take time and practice for both you and your baby. Your health care providers and
breastfeeding support groups can help.
Are you comfortable with breastfeeding? If you’re uncomfortable or have other

concerns about breastfeeding, your health care providers can help.
Is anyone trying to convince you one way or the other? Do what is right for you and
your baby. Do not let others make this decision for you.
How does your work or school situation affect your decision? Many women are able
to provide breastmilk even when they are away from their baby. In Alberta, women have
the right to ask for and receive workplace accommodation while breastfeeding.
Are there any health problems that will affect your ability to breastfeed? Talk with
your health care provider if you have any health concerns that may affect breastfeeding.
Is the cost of formula a concern for you in deciding how to feed your baby?
Adapted with permission from healthwise.org
To learn more about deciding how to feed your baby, visit the Links section at

Labour support
The first trimester is a good time to start planning ahead for labour, birth and beyond. You
may be thinking about who’ll help you during labour.
Your labour support person should be someone you trust, who knows you well, will go
to prenatal classes with you, and will comfort and support you during labour. While it’s
often your partner who takes on this role, you can choose anyone, such as a friend, parent,
sibling, aunt, cousin or grandparent.
More than one person can be with
you during labour. This works well
if your partner feels comfortable
sharing the job with someone else.
Ask your health care provider and

birth centre how many people can
be with you. Many birthing rooms
can only hold two support people.
If you do not have a labour support
person, talk with your health care
provider and childbirth educator
about labour support.
Prenatal and parenting programs

Prenatal classes (childbirth classes) are for parents, or a parent and their support person.
The classes will provide you with lots of tips to help you cope during pregnancy, labour
and birth. Prenatal classes can help you feel more confident by knowing what to expect.
At prenatal classes, you and your labour support person will learn:
“
■■ what happens to your body and your
baby during labour and birth With prenatal classes you get
■■ techniques and comfort strategies that to talk about pregnancy with
may help you during labour and birth others so it’s easier to stay calm
”
■■ choices you have during labour and birth and relaxed…there are others
in this boat with me.
■■ how your support person can help during
labour, birth, and after your baby is born ~ Lily, expectant mom
■■ how to breastfeed and look after your
newborn baby

Parenting programs are classes that help
you learn more about your child’s stages of
development, ways to help your child grow
and develop in a healthy way, and how
to cope when there are issues. Parenting
programs are for everyone, and the more
you know the more confident you’ll feel.
Your learning continues after your baby
is born.
Working around your schedule

Many prenatal classes are offered on
weeknights and weekends.
To learn more about online and in-person classes talk to your health care provider or
call Health Link at 811. There may also be specific classes for teenage parents, parents
having more than one baby, and parents who are more comfortable learning in their first
language. Be sure to register early, as classes fill up quickly. To learn more, visit the Links
Thinking about child care

Although it might seem early, you
may want to start thinking about
what child care will look like
following maternity or parental
leave. It can take time to find
something that works for you.
Deciding to leave your child in

someone else’s care can be very
emotional. Child care can create
anxiety for both parents and
children of any age. Think about what you’re anxious about and find out what you can do
about it. If you’re worried about cost, it might help to find out now what financial supports
are available to you. The most important thing to look for is quality of care. Knowing your
child is safe and well cared for will reduce your anxiety when you’re apart. Give yourself lots
of time to learn what your options are.
To learn more about child care, visit the Links section at


First Trimester:
The Beginning

89
First Trimester: The Beginning
The first trimester begins with many changes—some you may notice, some
you may not. During this time, the tiny embryo settles into your uterus.
Some parts of your body may start to feel tender. Your body provides a
safe, warm place, for your baby to grow. You may have mixed feelings—
excited one moment and worried the next. In this chapter, you’ll learn how
and why your body is changing and many ways to help you through the
first trimester.
90
Growing Together
FIRST TRIMESTER: THE BEGINNING

You and your baby will go through many changes during the first trimester—from the first
day of your last menstrual period to 13 weeks. Some of the changes pregnancy brings are
pleasant. However, you may have some changes that aren’t as pleasant, like nausea and
feeling tired. For helpful tips to deal with any uncomfortable changes you may have, see
page 96.
First Trimester
0–4
0–4 5–8 9–13 13–18 19–22 23–26 26–31 32–35 36–40
weeks
weeks weeks weeks weeks weeks weeks weeks weeks weeks
Changes in you
0–4 5–8
5–8 9–13 13–18 19–22 23–26 26–31 32–35 36–40
weeks weeks
weeks weeks weeks weeks weeks weeks weeks weeks
You may:
■■ feel
0–4tenderness 9–13
5–8 in your breasts,13–18
9–13 or you may not notice
19–22 any changes
23–26 26–31 at all
32–35 36–40
weeks weeks weeks
weeks weeks weeks weeks weeks weeks weeks
■■ know that your menstrual period is late
Changes
0–4
weeks
5–8
weeksin your
weeks baby
9–13 13–18
13–18
weeks
weeks
19–22
weeks
23–26
weeks
26–31
weeks
32–35
weeks
36–40
weeks
Your baby is called an embryo and is:

■■ about
0–4 0.6 cm 5–8(¼ inch)9–13
long, or 13–18
about the19–22
19–22 23–26 26–31 32–35 36–40
weeks weeks weeks weeks weeks
size of a grain of rice
■■ attaching (implanting) to the wall of
your
0–4 uterus5–8 9–13 13–18 19–22 23–26
23–26 26–31 32–35 36–40
weeks weeks weeks weeks weeks weeks
weeks weeks weeks weeks
■■ starting to form the early structures of
their brain
0–4 5–8 9–13 13–18 19–22 23–26 26–31
26–31 32–35 36–40
weeks weeks weeks
Your baby’s changing
environment
The
0–4placenta,
5–8amniotic sac and13–18
9–13 19–22 23–26 26–31 32–35
32–35 36–40
weeks
amniotic weeks
fluid begin weeks
to form. weeks weeks weeks weeks weeks
weeks weeks
©Lennart Nilsson/SCANPIX
0–4 5–8 9–13 13–18 19–22 23–26 26–31 32–35 36–40

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First Trimester
0–4 5–8
5–8 9–13 13–18 19–22 23–26 26–31 32–35 36–40
weeks weeks
0–4 5–8 9–13

9–13 13–18 19–22 23–26 26–31 32–35 36–40
Changes
weeks in you
weeks weeks
You may:
■■ 0–4 missed
have 5–8 9–13
your menstrual 13–18
13–18
period 19–22 23–26 26–31 32–35 36–40
■■ feel tired
■■ feel sick to your stomach or vomit
0–4 5–8 9–13 13–18 19–22
19–22 23–26 26–31 32–35 36–40
■■ weeks
not feel likeweeks
eating weeks weeks weeks
■■ feel strong emotions

0–4 5–8 9–13 13–18 19–22 23–26
23–26 26–31 32–35 36–40
Changes in your baby

Your baby’s:
0–4 5–8 9–13 13–18 19–22 23–26 26–31
26–31 32–35 36–40
■■ size
weeksis about 2.5 cm (1
weeks inch) long
weeks and they
weeks weeks weeks
weigh less than a grape
■■ heart starts beating
0–4 5–8 9–13 13–18 19–22 23–26 26–31 32–35
32–35 36–40
■■ weeks and brain
head weeks are taking
weeks shape
weeks weeks
■■ internal organs are forming

■■ teeth
0–4 begin5–8
to develop
9–13 13–18 19–22 23–26 26–31 32–35 36–40
36–40
weeks
■■ arm and leg buds are beginning to show
spine starts to show and bones begin
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■■ developtrimester
nerve First trimester
connections that will allow your baby
to move their limbs, hiccup, stretch
and yawn

0–4 5–8
5–8 9–13 13–18 19–22 23–26 26–31 32–35 36–40
weeks weeks
First Trimester

0–4 5–8 9–13
9–13 13–18 19–22 23–26 26–31 32–35 36–40
weeks weeks weeks
0–4 5–8 9–13 13–18

13–18 19–22 23–26 26–31 32–35 36–40
Changes
weeks in you
weeks weeks weeks
You may:
■■ be0–4 5–8 the top
able to weeks
feel 9–13 13–18
of your weeks 19–22
19–22 have
uterus, just ■■
23–26 26–31
constipation 32–35 36–40
weeks weeks weeks
above your pubic bone—it’s about the have a yellow or white discharge from
■■
size of an orange your vagina—this is normal

notice
0–4 changes
5–8 to your skin and
9–13 hair.
13–18 19–22 23–26
23–26 26–31 32–35 36–40
have slight bleeding
weeks from your vagina.
■■
■■
weeks
weeks weeks weeks
Skin problems may clear up or you may This is more common in women who’ve
develop a rash. already had a baby.
■■ feel
0–4sick at any
5–8 time of the day,13–18
9–13 not just 19–22
■■
23–26
haveweeks 26–31
26–31
gums that may look32–35 36–40
redder than
weeks weeks weeks
first thing in the morning usual. They may be swollen, tender to
■■ not feel like eating and you may vomit touch and bleed easily.
■■ 0–4 certain
crave 5–8
foods 9–13 13–18 19–22
■■ feel 23–26
tired 26–31 32–35
32–35 36–40
weeks weeks
■■ crave other things, like chalk or dirt ■■ have emotions that quickly change from
(pica)—talk with your health care happy one moment, to crying the next
provider
0–4 if this
5–8 happens
9–13 13–18 19–22 (mood swings)26–31
23–26 32–35 36–40
36–40
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care provider if you have bleeding from
vagina that will not stop or is getting worse.

Your baby is now called a fetus and is able to suck their thumb and make breathing
motions. Your baby’s:
■■ length is about 7.6 cm (3 inches) long and they weigh about as much as a tube of lipstick
■■ eyes, ears and nose have formed
■■ mouth has formed with lips, tongue and Your baby’s heartbeat
tooth buds You may be able to hear your
baby’s heartbeat at around
■■ hands, fingers, knees, ankles and toes
12 weeks through a fetal doppler.
have formed
■■ sex organs have formed
■■ legs are kicking—you can’t feel the kicks yet though
■■ basic brain cells are forming and developing very quickly, becoming more organized
and starting to connect to each other
fetal doppler: a device used to hear your baby’s heartbeat in the uterus


One of the best things you can do for you
and your baby is to take good care of yourself
both physically and emotionally. Your body is
going through many changes. Although you
may not look very different, you’ll likely feel
different.
You don’t need to gain much weight in

the first trimester, only about 0.5–2.0 kg
(1.1–4.4 lbs). Now’s a good time to start
setting weight gain goals for the rest of your
pregnancy (see page 26).
Eat healthy foods from the four food groups in Canada’s Food Guide. In the first trimester
you will not need any extra calories above what you normally ate before you were
pregnant. If you’re not already taking a daily multivitamin, start now and take it for the rest
of your pregnancy. Make sure your multivitamin has:
■■ 0.4 mg (400 mcg) folic acid
■■ 16–20 mg iron
■■ 2.6 mcg vitamin B12
■■ 400 IU vitamin D
Talk with your health care provider

about starting or continuing your
physical activity. You may need
to make adjustments as your
pregnancy progresses. Listen to
your body and try not to overdo it
(see page 44).
Take care of your mouth and teeth and continue to see your dentist regularly or schedule
an extra appointment if you have concerns. If you vomit, have heartburn or reflux, wait at
least 30 minutes to brush your teeth. Stomach acids can damage the tooth surfaces even
more if you brush your teeth sooner. You can rinse your mouth with a teaspoon of baking
soda in a cup of water and then spit it out. If you don’t have baking soda, rinse with water.
reflux: where stomach contents back up into the esophagus

Feeling uncomfortable?
You’ll notice lots of changes during the first trimester. While these changes can sometimes
be uncomfortable, they’re normal and common. Here are the reasons why and some ideas
to help you manage any of these discomforts.
Nausea or vomiting
Why?
This is also called morning sickness. It may be caused by changes in hormone levels,
more pressure in your abdomen, or being tired. It can happen any time, day or night.
Not all women have morning sickness. The symptoms can range from mild to severe
(hyperemesis gravidarum). It usually begins between 4–9 weeks of pregnancy and stops
around 12–16 weeks.
What you can do about it

■■ Get as much rest as you can—rest often ■■ Leave food like dry crackers, toast or plain
and before you become too tired. cookies at your bedside when you go to
sleep, so you have them ready for you in
■■ Get up slowly and move slowly.
the morning the next day.
■■ Take your multivitamin with food or before ■■ If you find you’re swallowing a lot of saliva,
bedtime.
try to spit it out instead.
■■ Eat several small meals rather than a few ■■ Try ginger to help settle your stomach.
large ones.
■■ Drink fluids between meals and in small
■■ Stay away from foods you know make you
amounts throughout the day. Try colder
feel sick.
fluids—sometimes ice chips help.
■■ Choose foods that are lower in fat and ■■ Limit or stop caffeine.
higher in protein like beans, lentils, fish,
poultry and lean meats. ■■ Try acupressure wristbands.
■■ If cooking smells are a problem, let others ■■ If you gag when you brush your teeth,
cook. Leave the room while food is being try using toothpaste that doesn’t foam
prepared, open windows and use the (sodium lauryl sulfate-free toothpaste) or
stove fan. a toothbrush with a smaller head to brush
your back teeth.
■■ Try not to lie down right away after eating.
Wait at least 1 hour unless you have your ■■ Try brushing your teeth with just water on
head raised. the brush and use a fluoride mouth rinse.
■■ Eat a snack at bedtime to help settle your ■■ Talk with your health care provider before
stomach. taking any medicine, including over-the-
counter or herbal remedies.
acupressure: an alternative medicine practice that applies pressure to certain parts of the body

You can help by:
■■ packing dry crackers, toast or plain cookies
for her lunch or leaving at her bedside
■■ cooking dinners
■■ letting your pregnant partner rest as much
as she needs to
■■ offering her cold fluids
! Call Health Link at 811 or your health care provider

if you can’t keep fluids down.
Tired
Why?
Feeling tired happens most in the first trimester because of changes in your
hormone levels.

■■ Rest often and before you become ■■ Eat smaller meals more often to keep your
too tired. energy at a constant level.
■■ Take short breaks with your feet up. ■■ Be physically active.
■■ Eat a healthy diet. ■■ Limit or stop caffeine.
“ ”
Staying active helped me a lot with the extreme tiredness. Also getting a good
night’s sleep helped me start each day fresh.
~ Kim, expectant mom

Headaches
Why?
Changes in hormone levels may cause you to have more headaches or they may be
worse than normal.
An increase in blood and fluid in your body.
May also be due to being tired and stressed.

■■ Get enough sleep. Take naps if you need to. ■■ Check your posture. Keep your chin level,
shoulders relaxed, abdominal muscles firm
■■ Try relaxation exercises or massage.
and knees soft.
■■ Put an ice pack on your forehead or the ■■ Talk with your health care provider before
back of your neck—don’t use heat.
taking any medicine, including over-the-
■■ Be physically active. counter and herbal products.
Dizzy and lightheaded
Why?
Your body makes more blood during pregnancy. The blood flow also slows down.
Sudden changes in position can make you dizzy.

■■ Always get up and change positions slowly.
■■ Eat and drink at least every 3–4 hours.
■■ Sit or lie down to rest.

Tender, puffy gums (pregnancy gingivitis)
Why?
Changes in hormone levels make your gums more sensitive and irritated by
bacteria (plaque).

■■ Brush your teeth twice a day with fluoride ■■ If you use tobacco or tobacco-like products,
toothpaste, especially before bedtime. Floss try to cut down and quit.
every day.
■■ Have your gums checked by a dentist or
■■ Use a soft toothbrush with just enough dental hygienist. Professional cleaning or
pressure to massage and clean along your products may be recommended.
gums and teeth to remove all the plaque.
Cravings
Why?
The reason some women have food cravings is unknown.

■■ Follow Canada’s Food Guide and think about ■■ Try a healthier choice, like fruit with yogurt
how foods can fit into a healthy diet. instead of ice cream or a glass of water
instead of a sugary drink.
■■ Limit foods and beverages high in fat, sugar,
salt and calories. ■■ If you crave dirt or other non-food items,
talk with your health care provider.

Passing urine more often than usual
Why?
This can be from changes in your body’s hormones and metabolism.
As the uterus grows, it puts more pressure on your bladder.

■■ Try not to drink as much coffee, tea or carbonated drinks because they are diuretics.
■■ When you go to the bathroom, lean forward to completely empty your bladder.
■■ Go to the bathroom as soon as you have the urge to pass urine—don’t hold it.
! Call Health Link at 811 or your health care provider if

it burns when you pass urine.
metabolism: how your body uses energy for basic functions to maintain life
diuretics: substances that increase the production of urine

Constipation
Why?
Changes in hormones slow down your bowel activity.
The iron in your multivitamin may cause constipation.

■■ Drink plenty of fluids like water throughout ■■ Try not to strain during bowel movements.
the day to quench your thirst. Your urine Proper positioning on the toilet can help.
should be light yellow or clear. Keep your back straight. Put a small step
stool under your feet to raise your knees
■■ Be physically active every day, unless your
higher than your hips. Keep your feet flat on
health care provider tells you not to.
the stool.
■■ Choose foods with lots of fibre (see ■■ Talk with your health care provider before
page 36).
using fibre supplements and medicine for
constipation or if constipation is a problem
for you.
Hemorrhoids
Why?
Pressure on the blood vessels in your rectum can slow blood flow and cause swelling in
the veins—this can cause burning, itching and some bleeding.

■■ Try to prevent constipation using the ■■ Try lying on your side instead of sitting.
suggestions in the constipation section.
■■ Use ice packs, cold packs and hemorrhoid
■■ Don’t strain during bowel movements. cream.
■■ Do pelvic floor muscle exercises every day. ■■ If the hemorrhoids bleed or hurt, talk with
■■ Don’t sit or stand for too long. Take time to
stretch if you’ve been sitting and time to
rest if you’ve been standing.

Mental health
Your mental health is just as important as your physical health and both contribute to your
overall health. Finding out that you’re pregnant may bring about many different emotions
that can affect your mental health. Here are some tips to help you along the way:
■■ Set reasonable expectations for yourself. Take time every day to rest and relax. Nap if you
need to.
■■ Eat regularly and make sure you drink plenty of water. A walk outside and some fresh air
can help you feel refreshed.
■■ Don’t be afraid to ask questions or talk about any concerns with your health care
provider or the other health care professionals at their office.
■■ Talk with other expectant parents. They’re probably going through many of the same
feelings as you. Getting to know them now will help extend your support system
once your baby is born. There are also online groups to connect you with other
expectant parents.
■■ Talk with your partner, friends and family who will listen and support you.
Changing emotions, including stress, anxiety and depression, can happen anytime in
pregnancy (see page 54).
“ Be positive and don’t get stressed: relax, breathe deep and dance!
”
~ Leta, expectant mom
Healthy sexuality
You may find that your level of sexual
desire comes and goes as your body
changes. Share how you’re feeling
with your partner and talk about what
works and doesn’t work.
Sexual intercourse is usually safe

during pregnancy. Contractions from
orgasm are not the same as labour
contractions.
contractions: rhythmic tightening and relaxing of the muscle of the uterus

Prenatal Care

Your first prenatal checkup should be around 6–10 weeks or after you’ve missed your first
period. Your health care provider will talk about your general health, your health history
including any previous pregnancies, may do a complete physical checkup and order
some tests.
Prenatal checkups You can build attachment with your
Your checkup may include: baby and support your partner by
going to appointments like prenatal
■■ a pelvic exam to check your cervix and checkups and ultrasounds together.
the size and position of your uterus
■■ checking your blood pressure
■■ a breast exam
■■ checking your weight and height and
talking about healthy weight gain
during pregnancy
■■ a Pap test to check for cancer of the
cervix or abnormal cells that could
lead to cancer. This test is only done if
your Pap test is due.
■■ routine blood and urine tests
Routine tests
Your health care provider will want to do some routine tests after your first appointment.
Routine tests are recommended for all pregnant women. The most common routine tests
during the first trimester are blood tests, urine tests and an ultrasound.
Depending on your risk factors, they may also talk with you about prenatal genetic
screening, screening for infections, and checking to see if you’re immune to certain
diseases.
Your health care provider will talk with you more about these tests and answer your
questions.
genetic screening: checks the DNA of your cells. It can find changes in your genes, or it can check the number, order,
and structure of your chromosomes.
immune: protected against disease

Hemoglobin
This blood test checks your blood to make sure it has enough healthy red blood cells to
carry oxygen for you and your baby. Hemoglobin is found in red blood cells. It carries
oxygen to the cells of your body and your baby’s body. When pregnant, your body makes
more red blood cells and more blood. Sometimes the increase in red blood cells doesn’t
keep up with the increase in the amount of blood. You may need more iron to increase
your red blood cells.
Blood type and antibodies

This blood test identifies your blood type and your Rh factor. There are 4 blood types:
O, A, B and AB. Everyone’s blood also has an Rh factor. You’ll be either Rh positive or
Rh negative. This may affect your care, your baby’s health and later pregnancies, so it’s
important to know this information early in your pregnancy. If you’re Rh negative, you’ll be
given an injection of Rh immunoglobulin in case your baby is Rh positive:
■■ at 28–32 weeks and after the birth of your baby, to prevent Rh problems in later
pregnancies
■■ if you have any bleeding during your pregnancy, to prevent possible health problems in
later pregnancies
■■ if you have an abdominal injury during your pregnancy, to prevent possible health
problems in later pregnancies
To learn more about Rh immunoglobulin, visit the Links section at

Rubella titre
This blood test checks if you’re immune to German measles (rubella). If you’re not, your
health care provider will talk with you about how to prevent getting rubella during your
pregnancy. Your provider will recommend you get immunized against rubella after your
baby is born. Getting rubella when you’re pregnant may cause eye, ear and heart damage
to your baby.
Varicella titre
This blood test checks if you’re immune to the chicken pox virus. If you’re not, your health
care provider will talk with you about how to prevent getting chicken pox during your
pregnancy. Your health care provider will recommend you get immunized against chicken
pox after your baby is born. If you get chicken pox during the first 20 weeks of pregnancy,
Rh immunoglobulin: a blood product given when there’s a chance that an Rh negative woman has formed Rh antibodies

your baby has a slight risk of having a rare group of serious birth defects. If you get chicken

pox just before birth, your baby may be born with a possible life-threatening infection.
Hepatitis B antigen
This blood test checks if you’ve been infected with the hepatitis B virus. Many people with
hepatitis B don’t know they have it. This infection can be passed on to your baby during
pregnancy or at birth. There are new treatments for hepatitis B that can lower the chance
of the infection being passed on to your baby. If your health care provider knows you’re
hepatitis B positive, you may be treated during pregnancy and your baby can be given
antibodies right after birth and start on an immunization series. This will likely prevent your
baby from getting hepatitis B.
Syphilis screening
This blood test checks if you’ve been exposed to syphilis, an STI. If untreated, syphilis can
cause late-term miscarriage, birth defects and stillbirth. If you test positive, which means
you’ve had or been exposed to syphilis, you can pass the bacteria on to your baby through
the placenta. Babies can also be exposed by contact with an active genital lesion during
birth. If you test positive, you’ll be treated with medicine to prevent the infection being
passed to your baby. Syphilis can damage your baby’s bones, teeth, vision, and hearing as
well as affect their brain development and cause anemia and lung infections.
HIV screening
This blood test checks if you have HIV antibodies in your blood. This virus may lead to
AIDS. If there are HIV antibodies, it means that you’re HIV positive—but it doesn’t mean
you have AIDS. HIV can be passed to your unborn baby through the placenta. It can also
pass to your baby at birth. Knowing if you’re HIV positive ahead of your baby’s birth gives
your health care provider more time to prevent the virus from passing to your baby and to
start your treatment earlier.
Urine tests
During these tests, your urine will be checked for bacteria and blood cells. Your urine is
tested for bacteria, whether you have symptoms or not. It’s important to catch and treat
a urinary tract infection (UTI) when you’re pregnant—you can have an infection even if
you don’t have any symptoms. If you have symptoms of a UTI, your urine will be tested for
bacteria as well as white blood cells. If either shows up, the urine sample will be sent to the
lab for more testing. The test will show if you have a UTI and which antibiotic will be best
to treat the infection while you’re pregnant.

Ultrasound
An ultrasound is sometimes done in the first trimester if you’re not sure how many weeks
pregnant you are (early dating ultrasound). It may also be done if the size of your uterus
doesn’t match how many weeks pregnant you think you are. Your health care provider will
talk with you about other ultrasounds you may need during your pregnancy.
Most ultrasounds are abdominal ultrasounds. Before the ultrasound, you’ll need to drink
enough water to make your bladder full. This helps raise the uterus closer to the surface
of the abdomen. You’ll lie on a bed in a dimly lit room. Gel is spread over your abdomen
before the ultrasound technician moves a small handheld device over your abdomen. The
ultrasound takes 20–45 minutes. A health care provider will discuss the results with you, at
your next prenatal clinic visit, or at the ultrasound clinic.
Other tests
All pregnant women will be offered a prenatal screening test for the most common
chromosome differences. For a few women, diagnostic tests may be recommended to
show if their baby has a chromosome or birth defect. Sometimes genetic abnormalities
or birth defects may be serious enough that the baby could have severe disabilities or
even die.
Prenatal genetic screening

Prenatal genetic screening is offered to show the chance that your baby has a
chromosome or birth defect. Genetic screening tests don’t diagnose how your baby is
growing and developing. They only tell your health care provider if more testing needs to
be done to make a diagnosis. Your health care provider will give you more information to
help you decide whether or not to have more prenatal genetic testing done.
The benefit of having these tests is that you’ll be given your screening results earlier in
your pregnancy. This gives you time to think about the results and whether you want more
testing, if it’s recommended.
■■ Maternal blood test is done between 9–13 weeks plus 6 days of pregnancy. It
measures 2 substances that are released from the placenta and found in your blood.
Changes to the levels of these substances may mean there’s an increased likelihood that
your baby has Down syndrome, trisomy 13 or trisomy 18. This blood test is done with
the nuchal translucency ultrasound (NT) as part of the first trimester screen. No results
are available with this blood test alone.

NT ultrasound is scheduled between 11–13 weeks plus 6 days of pregnancy. It

■■
measures the thickness of the layer of fluid at the back of your baby’s neck. This
measurement and the results of the maternal blood test are combined with your age to
estimate your likelihood of having a baby with Down syndrome, trisomy 13 or trisomy
18. This is called a first trimester screen. It’s also possible to find certain major birth
defects. The NT ultrasound may also be completed without the maternal blood test.
■■ Non-invasive prenatal testing (NIPT) is a maternal blood test to screen for an
increased likelihood for Down syndrome, trisomy 13 or trisomy 18. This test can be
done any time after 10 weeks gestation. The cost of this test is not covered by Alberta
Health Care.
Prenatal test used to make a diagnosis

■■ Chorionic villus sampling (CVS) is a diagnostic test done between 11–14 weeks of
pregnancy after screening tests show a higher likelihood of a genetic or chromosomal
disorder. An ultrasound is used to pass a small plastic tube (catheter) through the cervix
or a needle through the abdomen into the uterus to the chorionic villi in the placenta.
A sample of cells is removed for testing. There is a risk of miscarriage of 1/100 after the
procedure.
A health care professional will review the results and speak with you about your options
and what to expect.
To learn more about prenatal screening tests, visit the Links section at
chorionic villi: tiny finger-shaped projections found in the placenta. The genetic material in chorionic villus cells is
usually the same genetic make-up as the developing baby.

If Pregnancy Doesn’t Go
as Expected
Sometimes pregnancy doesn’t go as
expected, which can be disappointing,
make you angry or scared. Here is some
information that can help you understand
what is going on.
Miscarriage
A miscarriage is the loss of a baby before
20 weeks of pregnancy. A miscarriage may
happen suddenly, or gradually, over hours,
days or even weeks.
The first signs of miscarriage can be mild to moderate bleeding and cramping. However,
some women who have mild to moderate bleeding and cramping may still have a normal
pregnancy afterwards.
Miscarriages are more common than people realize. About 15–20% of pregnancies end
in miscarriage, most often during the first trimester. Sometimes miscarriages can happen
without you even knowing you’re pregnant, and may just seem like a late or a heavy
period. After the first trimester, the risk of miscarriage drops to about 3%.
Go to the emergency department NOW if you have any of the

following:
!!
■■ you’re soaking one thick feminine pad or more in 1 hour, for 2 hours
in a row
■■ you feel weak or dizzy
■■ you’re feeling abdominal pain that is new or is becoming stronger or
sharper or you have pain on one side

Possible causes

Most of the time, no one knows why a miscarriage happens. Some possible reasons are:
■■ a problem or abnormality with the baby ■■ tobacco use, alcohol consumption or
■■ being pregnant with more than one drug use by you or your partner before
baby and during pregnancy
■■ problems with your cervix or uterus

■■ domestic violence
■■ hormonal problems
■■ abdominal trauma
■■ infections, such as listeriosis

■■ STIs, like gonorrhea
■■ your age or health problems

■■ chemicals, like lead
Miscarriages are not caused by:

■■ too little or too much physical activity
■■ eating junk food
■■ not wanting to be pregnant
■■ having sexual intercourse
After a miscarriage, call Health Link at 811 or your health care provider
if you have any of the following:
cramping or pain in your abdomen
!
■
■ bleeding from your vagina that will not stop or is getting worse
■ passing blood clots larger than 2 cm (¾ inch)
■ discharge that smells bad
■ a temperature of 38° C (100.4° F) or higher
What to expect
Once a miscarriage begins, it can’t be stopped. It can take several days or weeks.
If you have Rh negative blood, you’ll be given Rh immunoglobulin. If you haven’t had your
blood type checked, you’ll need a blood test to find out if you’re Rh negative.
While many miscarriages don’t need to be treated, medicine may be given to you by your
health care provider to make contractions happen, or a procedure called dilation and
curettage (D and C) may be needed to clean out your uterus.

After a miscarriage
When a pregnancy ends in a miscarriage,
it can be a very emotional time for If you’re a partner
everyone. Feelings of fear, anxiety, anger You may feel helpless at this time. You
and grief are normal. Talk with family can provide emotional support and
and friends for the support you and your help communicate with health care
partner will need. Many people find it providers. It’s also important that you
get emotional support for yourself.
helps to talk with others who’ve also been
through a miscarriage. You may want to
look for a support group in your area. If you feel very sad or depressed and need emotional
support, a counsellor or your health care provider can help you work through the loss of
your pregnancy.
To learn more about miscarriages or to find support call Health Link at 811, talk with your
health care provider or visit the Links section at
If you’ve had a miscarriage, you may want to talk with your health care provider before
getting pregnant again. Most health care providers suggest that you wait until you’ve had
at least one normal menstrual period before you try to get pregnant again. Ask about birth
control options if you’re not planning another pregnancy right away. For more information
about birth control options, see page 257.

Second Trimester:
The Middle

111
Second Trimester: The Middle
The start of your 13th week marks the beginning of the second trimester
of your pregnancy. You may even have a ‘baby bump’ now. One of the
most exciting changes in this trimester is that you’ll start to feel your baby
move. You may also find the discomforts of early pregnancy lessen and
your energy returns. In this chapter, you’ll learn about the changes in the
second trimester.
112
Growing Together
SECOND TRIMESTER: THE MIDDLE

The second trimester goes from 13 to 26 weeks
of pregnancy. Whether you have other children
or this is your first pregnancy, the second
trimester is exciting because you’ll begin to feel
your baby move for the first time. This is called
quickening. Some women say it feels like tiny
bubbles or butterflies moving inside them. If this
is your first baby, you may begin to feel these
movements between 18–20 weeks. If this is not
your first baby, you may feel the movements
earlier—around 16 weeks.
“ The second trimester was great, my

nausea was finally over, then I felt my
”
baby move for the first time—I instantly
fell in love.
~ Olga, mom of two children
Second trimester
You may feel Braxton-Hicks contractions near the end of your second trimester and may
even be able to see your uterus contracting. These contractions are normal and aren’t
labour contractions. They help your
uterus get ready for labour and birth.
Braxton-Hicks contractions usually do
not hurt and may feel like a tightening
of your abdomen or a mild menstrual
cramp. They can happen anytime and
anywhere, lasting from a few seconds
up to 2 minutes. You’ll likely have them
more often in the last few weeks of
pregnancy. They will not get stronger,
longer, or closer together and will
stop after a few hours. You’ll continue
to have them right up to when your
labour starts.

0–4 5–8 9–13
9–13 13–18 19–22 23–26 26–31 32–35 36–40
weeks weeks weeks
Second Trimester
0–4 5–8 9–13 13–18

13–18 19–22 23–26 26–31 32–35 36–40
Changes
0–4
weeks
5–8
weeksin you
9–13
weeks
13–18
weeks
19–22
19–22
weeks
weeks
23–26
weeks
26–31
weeks
32–35
weeks
36–40
weeks
Your uterus
You may:
Your uterus is now the size
■■ feel
0–4your baby
5–8 move 9–13
for the first time
13–18 19–22 of a23–26
large grapefruit.
23–26 26–31 32–35 36–40
weeks weeks
(quickening) weeks weeks weeks weeks
■■ start to feel less tired ■■ notice that your breasts are less tender
■■ have
0–4 constipation
5–8 9–13 13–18 19–22■■ notice
23–26 26–31
that your nipples32–35
26–31 are darker36–40
weeks weeks weeks
■■ have your nausea and vomiting end or ■■ have a dark line down the centre of your
begin to go away abdomen (linea nigra). This usually starts
0–4
notice 5–8 9–13 13–18 19–22 to fade
23–26after your
26–31baby32–35
is born. 36–40
32–35
weeks thatweeks
your breasts begin weeks
to prepareweeks
■■
weeks weeks
for breastfeeding by making colostrum notice darker skin around your eyes and
■■
at around 16–18 weeks nose, which will also fade after birth
0–4 5–8 9–13 13–18 19–22 23–26 26–31 32–35 36–40
36–40
weeks
Your baby can hear you
Your baby is able to roll
&'&()*%+,'-./-.%0-1/$"-20-3 % over in your uterus.
Your baby’s: This is a big milestone—your baby
&'(#)*'+$',)-.*-($/'($')0$',)-.*-($1&2-0$3#4-)$*.$1.5,6 $ can now hear your voice! Take some
■■ weight is about 90 g (3 oz) and they’re time each day to talk, read or sing to
about 12.5 cm (5 inches) long. Curled up, your baby.
they’re about the size of a tennis ball.
■■ inner ears have formed—they can
hear you
■■ body is covered with fine, downy hair
(lanugo)
■■ hair and eyebrows begin to grow
■■ fingernails and toenails have developed
■■ taste buds have formed

0–4 5–8 9–13 13–18
13–18 19–22 23–26 26–31 32–35 36–40
Second Trimester

0–4 5–8 9–13 13–18 19–22
19–22 23–26 26–31 32–35 36–40
Changes
0–4
weeks
5–8
weeksin you
9–13
weeks
13–18
weeks
19–22
weeks
23–26
23–26
weeks
weeks
26–31
weeks
32–35
weeks
36–40
weeks
Your uterus
You may:
The top of your uterus is about
■■ have
0–4 more energy
5–8 9–13 13–18 19–22 as high
23–26as your belly button.
26–31
26–31 32–35 36–40
weeks weeks weeks
■■ notice your breasts getting bigger and
leaking colostrum ■■ feel a slight pain or a dull ache in your
■■ sweat
0–4 more5–8 9–13 13–18 19–22 lower abdomen
23–26 or groin32–35
26–31 when you
32–35 move
36–40
weeks weeks weeks weeks weeks weeks or sneeze
suddenly weeks weeks
weeks weeks
■■ have cramping in your leg muscles
■■ have vaginal discharge which is normal.
■■ have backaches Itching or burning is not32–35
normal—have
0–4 5–8 9–13 13–18 19–22 23–26 26–31 36–40
36–40
■■ have
weeksheartburn,
weeks indigestion
weeks orweeks weeks this checked by your health care provider
weeks
constipation
%&'&()*%+,'-./-.%0-1/$"-20-3 %
%&'(#)*'+$',)-.*-($/'($')0$',)-.*-($1&2-0$3#4-)$*.$1.5,6 $
Your baby’s brain
Your baby:
Your baby’s brain cells are making more
■■ will grow up to 18 cm (7 inches) during connections with each other every day.
these 4 weeks. By the end of 22 weeks By 20 weeks, your baby’s brain and
they’re about 25 cm (10 inches) long— nervous system are developed enough
about the distance from your elbow to to react to sound and light.
your wrist.
■■ weighs about 250 g (9 oz)
■■ is covered with a white, cream like
protective coating (vernix) that helps
keep heat in and moisturize their skin. It
also helps your baby pass through your
birth canal.
■■ will kick, twist and turn. They may be
most active when you’re sitting still.
■■ can grasp and suck

0–4 5–8 9–13 13–18 19–22
19–22 23–26 26–31 32–35 36–40
Second Trimester
0–4 5–8 9–13 13–18 19–22 23–26

23–26 26–31 32–35 36–40
Changes
0–4
weeks
5–8
weeksin you
9–13
weeks
13–18
weeks
19–22
weeks
23–26
weeks
26–31
26–31
weeks
weeks
32–35
weeks
36–40
weeks
You may:
■■ find
0–4 your breasts
5–8 get 9–13
bigger 13–18 19–22
■■ feel 23–26
your uterus squeeze32–35
26–31 and tighten
32–35 36–40
weeks weeks
■■ be looking more pregnant now (Braxton-Hicks contractions)
■■ start to get stretch marks

■■ have gums that look redder than usual,
0–4 5–8 9–13 13–18 19–22 are swollen
23–26 and may bleed
26–31 easily 36–40
32–35 36–40
■■ have
weekscramps in yourweeks
weeks feet and legs
weeks
■■ have gained about half of the weight
■■ have veins that swell (varicose veins) you’ll gain in your pregnancy
&'&()*%+,'-./-.%0-1/$"-20-3
■■ %
have an itchy abdomen
&'(#)*'+$',)-.*-($/'($')0$',)-.*-($1&2-0$3#4-)$*.$1.5,6 $
Your baby:
■■ is now about 32 cm (13 inches) long— ■■ moves around. You can feel the
about the distance from your elbow to movement when they’re high up in your
your fingertips abdomen or low down in your pelvis
■■ weighs around 1 kg (2 lbs), or as much as ■■ has finger and toe prints
a small melon ■■ has lungs that aren’t yet fully developed
■■ has a developed brain stem, which ■■ is developing a pattern of sleep and
controls their heart rate, breathing, blood activity
pressure and other vital functions
■■ can hiccup
■■ can open and close their eyelids


In the second trimester, you’ll
see your body changing in
shape and size. You may begin
to feel less tired and have more
energy. Keep taking care of
yourself both physically and
emotionally, it’s good for both
you and your baby.
You’ll start to gain more weight

now to support the growth
and development of your baby.
Track your weight gain and talk
with your health care provider
about your weight gain goals.
You’ll also need to eat more food

than during the first trimester—only Physical activity
about 350 extra calories a day. Choose All pregnancies are different. Listen to
an extra 2–3 servings each day from your body as it changes from month to
Canada’s Food Guide. Keep taking month. Do what feels comfortable for you.
your multivitamin with folic acid in it
every day.
The second trimester may be the best time to become more physically active because
the discomforts of early pregnancy, such as nausea and vomiting, have usually gone away.
If you weren’t active before you became pregnant, be sure to talk with your health care
provider about your activity. Being active during pregnancy has many benefits and can
improve the way you feel.
If you need dental treatment, your dentist may prefer to do it in your second trimester. Talk
with your dentist about the risks and benefits of the treatment. Keep brushing twice a day
with a fluoride toothpaste and floss every day.
You can find more information about taking care of yourself during pregnancy in the
Starting Off Healthy chapter on page 21.

You’ll notice different changes during the second trimester. While these changes can
sometimes be uncomfortable, they’re normal and common. Here are the reasons why and
some ideas to help you manage any of these discomforts.
Skin conditions
Why?
Your pregnancy causes many changes in your skin. These changes may include acne,
darker skin in some areas of your face and body, a dark line down the centre of your
abdomen and stretch marks—red streaks or marks on your abdomen, thighs or breasts.
Some rashes may be due to hormonal changes. New rashes, like red, sometimes itchy
bumps or blisters, can also develop. Allergies and viruses can also cause rashes.

■■ Oils and creams will not prevent stretch marks, but you may like to use these products on your
skin anyway.
■■ If you develop a skin condition during your pregnancy, ask your health care provider about
possible causes and treatments.
■■ Stretch marks will fade to white lines after birth.
■■ If you have a dark line down the centre of your abdomen, it will usually start to fade after your
baby is born.
Groin pain
Why?
Your ligaments can stretch with sudden movements like sneezing, coughing, standing
up or turning over.

■■ Try not to make sudden movements.
■■ Support your abdomen with your arms when you sneeze or cough.

Backache
Why?
Your posture and centre of gravity change as your baby grows. This puts more stress on
your spine and the ligaments and muscles of your back and thighs.
The hormones of pregnancy soften the ligaments and cartilage in your pelvis and back
as a way to get ready for birth.
As your baby grows, your abdominal organs are pushed upwards.
As your breasts become bigger and heavier, you may find you slouch more.

■■ Use good posture (see page 50). ■■ Ask your partner or support person to give
you a back rub.
■■ Wear comfortable, low-heeled shoes.
■■ Do stretching exercises.
■■ Wear a bra that fits well.
■■ If the pain doesn’t get better or go away,
■■ Try using a warm water bottle or ice pack on
talk with your health care provider.
your back.
Increased vaginal discharge
Why?
Changes in your hormone levels.
This is normal as long as the discharge is white or clear and doesn’t smell.

■■ Wear cotton underwear. ■■ Avoid douching (using water to clean inside your
vagina). It’s not necessary and can lead to infections.
■■ Use non-scented panty liners.
Call Health Link at 811 or your health care provider if the
!
discharge from your vagina:
■ is like water, or
■ itches, burns or smells bad

Leg cramps
Why?
There can be more pressure on the nerves in your abdomen as your baby grows.
Standing all day can put extra strain on your legs.

■■ Try not to stand for too long. ■■ Do calf-stretching exercises.
■■ Try not to point your toes. ■■ To relieve spasms, gently push your foot
against a firm surface, or have your partner or
■■ Rest—put your feet up several times
support person gently push against your foot.
during the day.
Varicose veins
Why?
Blood flow in your legs is slower because of the extra weight and blood your body has
made. This causes your veins to swell.
Varicose veins look like dark blue cords running along your legs.
Varicose veins tend to run in families. If someone in your family had them, you might too.

■■ o not stand or sit in one position for
D ■■ Wear full length support stockings.
too long. ■■ Do not wear knee-high stockings, as they
■■ Try not to cross your legs or feet. may cause the blood in your lower legs
to pool.
■■ Put your feet up several times a day.
Call Health Link at 811 or your health Call 911 NOW if

care provider if: you have any of
one foot, ankle or calf becomes the following:
! !!
■■
more swollen than the other ■■ trouble

■■ you have a red, painful and hot lump breathing
in your lower leg—do not massage it ■■ painful
■■ one of your lower legs are throbbing, breathing
tender or ache ■■ chest pain

Lying down and getting up

If you’re feeling uncomfortable when lying down, try lying on your side and:
■■ bend your legs and put a pillow between your knees and ankles
■■ put a pillow under your abdomen and behind your back
To get up from lying down on a bed or couch:

1. Roll onto your side.
2. Bend and swing your legs over the edge.
3. Use your hands to push yourself to a sitting position.
4. Use your leg muscles to stand.
To get up off the floor:

1. Get onto your hands and knees.
2. Put one foot on the floor and keep the other knee on the floor.
3. Use your leg muscles to stand.
Mental health
During this trimester, your baby may feel more real to
you—you may find yourself saying, “I’m having a baby”
rather than “I’m pregnant.” You can feel your baby move
and you may focus your attention inward to your baby
and your own thoughts and feelings. Your second
trimester may bring about other feelings as well. You may:
■ enjoy how you look, or feel less attractive
■ be more sensitive with stronger emotions
■ have fewer mood swings
■ have more vivid dreams than before you
were pregnant
! Call Health Link at 811 or your health care provider if you or your partner
feels depressed or anxious (see page 63).

It’s common in this trimester to daydream about your role as a parent. You may feel all
kinds of emotions:
■■ a sense of pride and excitement about ■■ uncertainty about the future and
becoming a parent having more responsibility
■■ worry about the health of your partner ■■ more protective of your partner
or your unborn baby ■■ left out as your partner focuses on
■■ worry about finances herself and the baby
■■ stress in your relationship
Ask questions and talk to each other about how you're both feeling. Look for ways you
can cope with stress and changing emotions together.
Things you can both do

Here are some things you can both do to cope with stress and changing emotions:
■■ take a walk together ■■ make time to talk and share your
■■ go to ultrasound appointments feelings
together. This is a great time to meet ■■ find support from family, friends and
your new baby. others in the community
■■ go to prenatal visits together ■■ get plenty of sleep, eat well and be
■■ learn about pregnancy and parenting active together

Healthy sexuality

Your sexual desire may change
as your body changes. During Important to know
pregnancy, there’s more blood If your health care provider tells you not to have
flow to your pelvic area, which sex, that means anything that involves orgasm or
may increase pleasure during sexual arousal, not just vaginal intercourse.
sexual activity.
You may feel uncomfortable in some positions. You may need to experiment to find
positions that are comfortable and pleasurable, like lying sideways. Some women may also
find it more comfortable to be upright or sitting on top during sexual intercourse.
Prenatal Care
Prenatal checkups
Checkups are a good time to ask about healthy
eating, physical activity, your mental health,
feeding your baby and any other questions you
may have about your pregnancy.
To check your health and your baby’s growth
and development, your health care provider
will usually:
■■ Check your weight gain.
■■ Check your blood pressure.
■■ Check your hands and feet for swelling.
■■ Measure your fundal height and listen to
your baby’s heartbeat.
■■ Ask you about your baby’s movements.
■■ Order other routine tests and explain them
to you.
fundal height: a measurement taken from the top of a pregnant woman’s pubic bone (symphysis pubis) to the top of
her uterus (fundus)

Routine tests
Your health care provider will want to do some routine tests during the second trimester.
They will talk with you, your partner, or a support person about these tests and answer
your questions.
Ultrasound
An ultrasound will be offered between 19–20 weeks. The ultrasound checks:
■■ how many weeks pregnant you are, if ■■ how your baby’s internal organs, arms
you’re not sure when your last menstrual and legs are growing
period was and did not have an earlier ■■ the amount of amniotic fluid surrounding
dating ultrasound your baby
■■ if your baby is a good size for their age ■■ where your placenta is located
■■ your baby’s heart rate and movements ■■ whether you have one baby, twins,
or more
While an ultrasound can help identify

some health issues early, it can’t
identify all issues that might happen.
Ultrasounds are safe for both you and
your baby.
Sometimes you may need to go back

for another ultrasound if the technician
couldn't see everything they needed
to. More ultrasounds may also be
needed for medical reasons.
Diabetic testing or glucose tolerance test

This blood test will be done between 24–28 weeks to screen for diabetes caused by
pregnancy (gestational diabetes). The hormones that are made during pregnancy change
the way your body uses sugar. This change helps your baby grow. However, in some
women, these hormones are out of balance and cause high levels of sugar in the blood.
About 3–10% of pregnant women will develop gestational diabetes.
For this test, a blood sample is taken an hour after you drink a sweet liquid to measure
the amount of sugar in your blood. Some women who have risk factors for gestational
diabetes may be tested again later in pregnancy.

Other tests

Sometimes prenatal screening tests (genetic testing) are offered to check your health or
your baby’s health. Your health care provider will talk with you and your partner about
these tests and answer your questions. If there are any concerns about your pregnancy,
you may be referred for genetic counselling, which may include prenatal testing options.
Maternal serum prenatal screen

Maternal serum prenatal screen (MSPS or
quad screen) is a prenatal genetic blood Genetic screening
test that you take when you’re 15–20 weeks While genetic screening can relieve
pregnant to screen for some chromosome concerns for some parents, for others,
differences and birth defects. MSPS tests it can bring more worries. Talk with
your partner and your health care
your blood for placental factors to estimate
provider if you have questions.
the likelihood of your baby being born
with Down syndrome or trisomy 18. It can
also screen for two birth defects—one in your baby’s neural tube and the other in their
abdominal wall.
MSPS is not needed if you have already had a first trimester screen (see page 106).
Amniocentesis
Amniocentesis is a test sometimes done if a screening test or ultrasound shows a higher
likelihood of a genetic or chromosomal difference. There is a risk of miscarriage after the
procedure. This test is done after 15 weeks. A needle is inserted through the abdomen and
into the uterus to take a sample of the amniotic fluid for testing.

If you’re expecting twins, triplets or more, you’ll often find out early in the second trimester.
If your health care provider thinks you’re expecting more than one baby, an ultrasound will
be done to find out for sure.
If you’re expecting more than one baby, your pregnancy can be both exciting and more
challenging. Here are some things to keep in mind:
■■ Good prenatal care and good nutrition are important for all of you.
■■ Talk with your health care provider about healthy weight gain recommendations for
your pregnancy (see page 37).

■■ You may experience more of the physical changes that happen during pregnancy. For
more information, see page 114.
■■ You may need extra rest to help your body cope with the work of carrying more than
one baby.
■■ You’ll probably see your health care provider more often and be referred to an
obstetrician. You may then only see an obstetrician, or care will be shared between
your health care provider and an obstetrician.
■■ You'll probably have extra ultrasounds to check the growth of your babies.
■■ Look for prenatal classes in your area for parents expecting more than one baby.
“ What really has helped a lot is that we found a prenatal class specifically for
”
multiples. You get into a group and you ask your questions and you bounce
ideas back and forth.
~ Linda, expectant mom of twins
Planning Ahead
The second trimester is a good time to start getting your home and yourself ready for your
baby’s arrival. You may have more energy now than you did in the first trimester.
Prenatal classes
Now is the time to book
your prenatal class!
Plan to take your support
person with you. If you
do not have a support
person, talk to your health
care provider.

“ Going to prenatal classes made me less anxious about the arrival of our

daughter. Our instructor was funny and helped make our group feel
”
comfortable together. On the way home from class, we would talk about
what we learned and what strategies we thought would work for us.
~ Ahanu, dad of a baby
Your birth wishes

It’s a good idea to think ahead and talk about the kind of birth experience you want
with your labour support person. This will also help you work together with your health
care providers.
Think about the things you want and do not want to be a part of your baby’s birth and first
few hours. You may want to write these down for yourself, and also talk about them with
your health care provider. If you do not want to write your birth wishes down, you can talk
with the health care providers at your birth centre when you’re admitted.
By talking with your health care provider at your prenatal appointments, you can make
sure that your wishes fit with the birth centre’s policies and make sure that what you’re
hoping for is possible. When you go to the birth centre, take your birth wishes with you.
Show them to the health care providers so you can talk about them together.
Keep in mind that every birth is different and the birth of your baby may not turn out
exactly as you’d hoped. Try to be flexible in case things change. Sometimes plans change
for medical reasons or sometimes you may change your mind and want something
else—remember that the goal is a safe birth for both you and your baby. Your health care
providers will discuss any changes in plans for medical reasons with you as they happen.
For information to help you make your birth wishes see the Labour & Birth: The Big Event
chapter on page 163 and Breastfeeding chapter on page 273.

Things to think about for your birth wishes
Who will be your labour support person?
Who else do you want to have with you during labour or as a backup?
What positions would you like to try during labour? It helps to have a few positions in mind.
In what position would you like to give birth?
What are your thoughts on handling labour pain? What’s your first choice on handling
labour pain? What’s your second choice?
Will you be breastfeeding immediately after your baby is born?
Who do you want to cut the umbilical cord?
What traditions from your community, if any, would you like to follow?
Would you, your baby and your labour support person like a few minutes alone right
after the birth, if possible?

Storing your baby’s cord blood

Some parents may choose to store blood from their baby’s umbilical cord. The cord blood
is full of cells called stem cells. These cells have an important role in helping the immune
system fight disease. Stem cells can help children who have weak immune systems and
can also be used to treat certain diseases, like leukemia or other health conditions.
Talk with your health care provider at the beginning of your second trimester if you want
to collect and store cord blood, as birth centres do not routinely collect cord blood for
storage. There is likely a cost involved if you want to store your cord blood.
To learn more about cord blood, visit the Links section at

Circumcision
Circumcision is when the foreskin of the penis is removed. Circumcision is not routinely
recommended for all newborn males, but there may be benefits for some. Your baby must
be stable and healthy to be circumcised. It may be done at your health care provider’s
office or at your birth centre. There is a cost involved. You may decide to circumcise your
baby for personal, religious or cultural reasons. You’ll need to make a decision based on
your own values, while also knowing the benefits and risks.
To learn more about circumcision talk with your health care provider, or visit
Maternity and parental leave

If you’re employed, check your company’s policy on maternity
and parental leave. To learn more about employment standards in
Alberta call toll-free at 1-877-427-3731, or visit the Links section at
To learn more about the federal employment insurance

maternity and parental benefits call toll-free at 1-800-206-7218,
for TTY call 1-800-529-3742, or visit the Links section at
stem cells: young, immature cells in cord blood that can copy themselves to replace or rebuild blood and immune
system cells
foreskin: a fold of skin that covers and protects the rounded tip of the penis

Baby supplies
Babies do not need many supplies. They grow quickly and move through developmental
stages quickly, so think about buying only a few things at first, then buy more as you
need them.
Here are some things to think about before buying supplies:

■■ Do you know anyone who just had a baby? Would they give, lend or sell you supplies?
■■ If you use second-hand items, like cribs or toys, sanitize them with a solution of 2 ml
(½ tsp) of household bleach in 1 L (4 cups) of water before using them. For stuffed toys,
add them to your laundry.
■■ If you buy new or use second-hand clothes or bedding, wash them before using.
■■ Watch for sales. Baby items go on sale at least once a season. You may not want to buy
too many clothes too far ahead—babies grow at different rates and it can be hard to
predict the clothing sizes you’ll need for each season of the year.
Older equipment may not meet today’s

Baby walkers are not safe
safety regulations. To learn more about safety
Do not use baby walkers—they’re
information and recalls on second-hand
not safe and have been banned in
Canada since 2004.
supplies, visit the Links section at
Clothing
When buying clothing, look for clothes:
■■ that you can machine wash and dry
Baby clothes
■■ that are easy to put on and take off—front
Do not put clothes on your baby
openings are better than back openings
that are too big—they can ride up
■■ without buttons, drawstrings, ties or other around your baby’s neck and can
decorative items sewn on—they are not choke or smother your baby.
safe as they can cause choking
■■ that are nylon or polyester—they do not catch fire as easily as cotton and cotton-blend
fabrics. If you choose cotton and cotton-blend, make sure the sleepwear fits well, as
loose clothing is more likely to catch fire.

Cloth and disposable diapers

You’ll need to decide if you want to use cloth or disposable diapers—each has its pros and
cons. You may even decide to use both. When deciding which kind of diapers to use, think
about the cost, convenience and what works for your family. Your newborn will use at least
10 diapers a day.
Cloth diapers
■■ come in many styles
■■ are fastened with pins, Velcro® or snaps
■■ are reusable—need to be washed in very hot water or on a sanitation cycle
■■ may be rented from a diaper service, made or bought
■■ may need to be covered with plastic pants (diaper covers)
Disposable diapers
■■ come in many styles
■■ may be fastened by sticky tabs
■■ are not reusable and may not be biodegradable
■■ need to be bought
■■ do not need plastic pants to cover the diaper
Bathing and body care supplies

Here are some basic bathing and body care supplies you’ll need:
■■ mild, unscented soap and shampoo
■■ soft brush
■■ towels and washcloths
■■ emery board—not nail clippers
■■ plastic baby bathtub

Cribs, cradles and bassinets
Babies spend a lot of time sleeping and the safest place for them to sleep is on their back
on a firm, flat, uncluttered surface. This will reduce their risk of SIDS, as well as prevent
them from being trapped or smothered. It’s safest to have your newborn in your room
with you in their own crib, cradle or bassinet. A safe crib, cradle or bassinet has no plastic
mattress covers, heavy blankets, quilts, sheepskins bumper pads, toys, stuffed animals or
pillows in it.
The crib, cradle or bassinet must meet

Canadian safety regulations. If you’re
borrowing or buying a used crib, cradle
or bassinet, make sure it comes with
the manufacturer's instructions or that
they are available online. Instructions
should include the model, date of
manufacture, assembly instructions
and warnings.
Do use a crib, cradle or bassinet if it has: Do not use a crib, cradle or bassinet if it:
■■ a mattress with the right thickness ■■ has any missing, loose, worn, broken or
a crib mattress that’s firm and not thicker damaged parts
than 15 cm (6 inches). Some crib mattresses ■■ is older than 10 years
have a soft side and a firm side—make sure ■■ has any fabric on the sides of the bassinet
the firm side of the mattress is facing up. or cradle that doesn’t attach securely to
a cradle or bassinet mattress that’s firm and the frame
not thicker than 3.8 cm (1 ½ inches) ■■ has any decorative cut-outs, corner posts
■■ posts that are not higher than 1.5 mm or large spaces between the bars that are
(1/16 inches) higher than 1.5 mm (1/16 inches)
■■ a tight-fitting mattress with a gap less than ■■ spacing between the bars that is more
3 cm (1 3/16 inches) between the sides and the than 6 cm (2 3/8 inches)
mattress. Push the mattress firmly against the
sides to test this.
■■ spacing between the bars that is 6 cm (2 3/8 in)
or less

Playpens

Playpens are for supervised play, and
not meant for unsupervised sleep. Standards and recalls
They do not have the same safety To learn more about crib,
standards as cribs, cradles or bassinets. cradle, bassinet and playpen
Information on playpens can be standards and recalls, visit the
Links section at
found in the book, Healthy Parents,
Healthy Children: The Early Years or visit
Car seats
You’ll need a car seat to bring your baby home from the birth centre. If your baby will be
travelling in a car, van or truck, they must be in a car seat—it’s the law. It’s also the only safe
way for your baby to travel in a vehicle. You can buy the car seat early and practice putting
it in your car.
Your child is safest in a rear-facing

car seat until they’re at least 2 years Winter clothing
old or reach the maximum weight and car seats
or height limit of the rear-facing seat Dress your child so they are
recommended by the manufacturer. Some car snug in the harness. Use thin,
seats are designed for rear-facing use up to 18 kg warm layers like fleece or a light
snowsuit. You can add a blanket
(40 lbs) or more. Rear-facing car seats that have
over top of the harness.
higher weight and height limits, are preferred,
and will keep your child safer.
Buying a new car seat from a Canadian store is the safest choice for your baby. If you buy
or borrow a used car seat make sure:
■■ it’s not past its expiry date
■■ it comes with instructions and has a sticker with the model number and date of
manufacture
■■ you know the history of the seat. Do not buy or use a car seat if it was in a motor
vehicle collision.
■■ it’s in good condition with no worn, loose or broken parts

Register your new car seat with the manufacturer after buying it. If you have an older car
seat, contact the manufacturer to check for recalls or replace lost instructions. Car seats
made prior to January 1, 2012 should not be used because they may not meet today’s
safety standards. To learn more about car seats and recalls, call Transport Canada toll-free
at 1-800-333-0510. To learn more about buying car seats and recalls, visit the Links section
Use the Rear-facing Car Seat YES Test to help you properly install the car seat in your vehicle
and buckle up your baby safely every time (see page 222).

Other supplies

There are a few other supplies you may find handy:
Breast pumps
■■ breastfeeding bras—buy them a month or less
You do not need to buy or rent
before your baby’s due date to make sure they fit
a breast pump before you’ve
■■ cotton breast pads had your baby. You may find
that expressing your milk by
■■ laundry hamper
hand works well for you. If you
■■ diaper pail with lid need a breast pump after your
baby is born, talk to your health
■■ digital thermometer—for use under the arm.
care provider.
An ear thermometer is only for children over
2 years of age.
■■ cloth baby carrier, sling or a stroller that meets today’s safety standards
For information on baby and child carriers, see page 241.

For information on strollers, visit the Links section at
Buying bras for breastfeeding

Many women may want to wear a nursing bra while breastfeeding, as
their breasts are larger and they may feel more comfortable with extra
support. Others prefer not to wear a bra at all. This is a personal choice,
based on your comfort. If you choose to buy a nursing bra:
■■ Wait until a month or less before your baby’s due date to buy your
nursing bra. If you buy it too early, it may not fit you when you need it.
■■ Shop where you can get help with measurement and selection. It's
hard to properly fit a bra yourself.
■■ Buy bras that fit comfortably on the last or second-last hook. This
allows for a smaller fit after birth when your rib cage size returns to
normal.
■■ The cup size should let you add breast pads without becoming too
tight. A bra that's too tight can decrease your breastmilk supply.
■■ Seams should not press into your breast. Pressure can lead to blocked
ducts. Do not wear underwire bras.
■■ Different bras have different features. Bras that are 100% cotton will
breathe better but may shrink when washed. Bras with spandex may
offer more stretch when breasts are full, but may not offer enough
support for some women with larger breasts.

How many of each item do you need for your baby?
❑ 3–8 snap-front undershirts

❑ 3–8 sleepers
❑ 2 sweaters
❑ 3–8 bibs
❑ 1 toque and sunhat for outdoors, depending on the season
❑ 6 receiving blankets
❑ 1 pair booties or socks
❑ 1 one-piece snowsuit with legs for the winter months
❑ 2–4 fitted crib sheets
❑ 3–4 lightweight blankets that can be tucked firmly under all 3 sides of the mattress
“ You have so many questions when you’re pregnant and it’s so nice to talk to
other women. My best support came from my baby group. It just was so nice to
have people to talk to who were feeling the same things I was feeling and the
same pains and wasn’t sick of listening to me talk about the topics that were
”
crucial to me at that point. You need someone in your life who understands you
in this important time.
~ Trish, expectant mom

If Pregnancy Doesn’t Go

as Expected
Sometimes pregnancy doesn’t go as expected which can be disappointing or scary. Here's
some information that can help you understand what is going on.
Gestational diabetes
Gestational diabetes is diabetes that only happens during pregnancy. It can cause a baby
to grow larger and faster. This may cause challenges during delivery. Your baby may also
have low blood sugar at birth. Your health care provider will check the level of sugar
in your blood later in the second trimester to find out if you have gestational diabetes.
Some health care providers may also check the level of sugar in your urine at prenatal
appointments.
You'll receive additional support and care to learn how to manage the gestational diabetes
if you have it. You can usually manage it with changes in your diet and physical activity
level. You may also need to take medicine and test your blood sugar levels. Often you’ll be
loaned a monitor to measure your blood sugars. If you are, remember to bring this monitor
to the birth centre when you have your baby. Keep your gums healthy because gum
disease can make diabetes harder to manage.
High blood pressure

High blood pressure during pregnancy can cause serious problems, like pre-eclampsia.
Your health care provider may check your blood pressure at every prenatal visit.
Call Health Link at 811 or your health care provider NOW if you have any
of the following:
! ■■
■■
■■
a headache that will not go away
a sudden weight gain
sudden swelling of your hands
■■
■■
■■
problems with your vision
a very bad pain under your rib cage
sudden, unexplained nausea or
and face vomiting
pre-eclampsia: high blood pressure and protein in the urine after 20 weeks of pregnancy

Preterm labour
Preterm (premature) labour is labour that starts between 20–37 weeks of pregnancy.
About 7–9% of babies are born preterm. Preterm babies need extra care because they are
born before their bodies are ready for life outside the uterus. If you go into preterm labour,
your health care provider may try to stop the labour to give your baby a chance to develop
more before birth.
Usually, the earlier your baby is born, the greater the likelihood that there will be
challenges. Premature babies are more likely to have breathing, vision and feeding issues.
They also get infections more easily.
Preterm labour can happen in any pregnancy. Half of all preterm births happen to women
with no known risk factors. To reduce your risk for preterm labour:
■■ Go to all of your prenatal appointments.
■■ Eat healthy foods, drink lots of fluids, be active and get lots of rest.
■■ Use coping strategies to reduce your stress.
■■ Cut down and quit alcohol, tobacco and tobacco like products, cannabis and
other drugs.
■■ Practice safer sex to reduce your chance of getting an STI (see page 56).
■■ Prevent injuries and call your health care provider if you have been injured or fallen,
or if you were in a motor vehicle collision and you weren’t taken to the hospital by
an ambulance.
■■ Talk with your health care provider about your working conditions.

Signs of preterm labour

Know the signs of preterm labour and to trust your instincts. If you think something’s
wrong, call your health care provider or go to your birth centre—it can make a big
difference to your baby’s health. Getting medical care may reduce the chance of
preterm birth.
Call Health Link at 811 or your health care provider if you notice any
signs that could be preterm labour:
■■ contractions that may or may ■■ fluid gushing or leaking from
not hurt the vagina
!
■■ abdominal cramps, that may feel ■■ a change in or more vaginal
like menstrual cramps or gas discharge
pains ■■ discharge that smells bad or that is
■■ diarrhea not white or clear
■■ a change in lower back pain ■■ pressure in the pelvis or lower
■■ spotting or bleeding from abdomen
the vagina ■■ a full or heavy feeling in the vagina
If you’re in preterm labour, your contractions will be monitored at the birth centre and
your baby will be assessed. Your treatment may include bed rest, fluids and medicine to
help your baby’s lungs mature. Medicine may be given to try to stop your labour. If your
contractions stop, you may be sent home.
“ Our baby boy was born very early…he needed to be in the incubator…
Nurses encouraged us to begin skin-to-skin with both of us. I feel this made a
”
world of difference to our baby and to us in helping with healthy growth and
attachment…even in our connection now, years later.
~ Carlie, mom of a preschooler

If your baby is born preterm
There are many reasons why
babies are born preterm. If this
happens, your baby may be
moved to a neonatal intensive
care unit (NICU) which could be
in another hospital. Your baby
will need supports as they are
not ready for life outside your
uterus. They may need help with
breathing and staying warm.
Special equipment like monitors
and feeding tubes will be used
to help care for them while they
Reproduced with permission from Gantefoer, H. (2010).
adjust to the outside world.
You’ll be encouraged to touch, talk and cuddle your baby skin-to-skin when your baby
is ready. Being skin-to-skin helps to keep your baby warm and build attachment. If you’re
planning to breastfeed, your health care
providers will help you to pump or express
your breastmilk to feed your baby until
they’re ready to breastfeed. If your baby is in Holding your baby skin-to-skin
will help keep your baby warm
the NICU, health care providers will want you
and build attachment too!
to take part in your baby’s care.
Ask lots of questions and talk
Having a premature baby can cause a lot of to each other about how you’re
different emotions. The health care providers feeling and how best to support
will give you the information and the support each other.
you need. You can ask any questions you
have and talk with them about your concerns.
skin-to-skin: cuddling your baby bare chest to bare chest, with your baby’s back covered with a blanket

Miscarriage and stillbirth

A miscarriage can happen in the second trimester when you’re less than 20 weeks
pregnant. They are much less common than in the first trimester. For more information
about miscarriage, see page 108.
Stillbirth is the death of a baby after 20 weeks

of pregnancy that happens before birth. This If you’re a partner
can happen during pregnancy or labour. The Feelings of fear, anxiety,
death of a baby is not something any parent anger and grief are normal.
expects—it shatters hopes and dreams. Losing a You may also feel helpless
at this time. You can provide
baby may be overwhelming and the grief can be
emotional support and help
deep for parents and their families. communicate with health care
providers. It’s also important
If this happens, take as much time as you need
that you get emotional
to grieve the loss of your baby and to find support for yourself.
support to cope with your loss. You may want to
learn about why your baby died and if there is
something you need to know when planning another pregnancy.
After a stillbirth
You’ll be asked if you want to see and hold your baby. This is an important part of grieving
and helps you make memories with your baby. You can bath and dress your baby or take
pictures. You’ll also be asked to name your baby and to register your baby as a stillbirth.
You’ll be offered an autopsy and other tests to see if the cause of your baby’s death can
be found. An autopsy is the best way to find out the cause of death. If the cause of death
can be found by autopsy, it may help answer the question “Will it happen again?” Some
parents may find comfort in learning as much as possible about the death of their baby.
The results may also improve care for your next pregnancy or for other women. If you’re
not sure about having an autopsy, ask your health care provider about other options such
as an examination by a pathologist or a partial autopsy. You’ll also need to decide about
burial or cremation. The birth centre will help you with the information that you’ll need to
make these decisions.
autopsy: medical procedure done on a body after death to learn the cause of death

The experience of grief and getting support
Everyone reacts and grieves differently after tragic losses. You may cry a lot or feel angry,
hopeless, shocked or confused. You may want to blame yourself or someone else. It might
be hard to eat or sleep.
You’ll be asked if you want to see a grief counsellor, spiritual advisor, social worker or
public health nurse to help support you and your family, and to refer you to resources
and supports in your community. Family and friends may also want to help you.
Consider accepting the help they offer and tell them what they can do to help you when
you’re ready.
To learn more about grief support, call Health Link at 811, talk with your health care
provider or visit the Links section at healthyparentshealthychildren.ca/resources

Third Trimester:
The Final Stretch

143
Third Trimester: The Final Stretch
At 26 weeks, you move into the third trimester—the last part of your
pregnancy journey. Your baby and your abdomen keep growing and you
may find yourself slowing down. This is a time when you may feel more
emotional—you may feel a little bit excited and a little bit scared. Now it’s
more important than ever for you and your partner to take care of yourselves
so you’re ready for the day your baby arrives. In this chapter, you’ll learn about
the changes in the third trimester, building on what you’ve already learned.
144
0–4 5–8 9–13 13–18
13–18 19–22 23–26 26–31 32–35 36–40
Growing Together
THIRD TRIMESTER: THE FINAL STRETCH

0–4 5–8 9–13 13–18 19–22
19–22 23–26 26–31 32–35 36–40
You and yourweeks
weeks baby have been through
weeks weeks many changes
weeks
weeks together.weeks
weeks Your baby is almostweeks
weeks ready
for life in the outside world. As your baby gets bigger, try to lie on your side and not your
back. This will help move the weight of your baby off of the blood vessels that lie behind
your0–4uterus. 5–8 9–13 13–18 19–22 23–26
23–26 26–31 32–35 36–40
Third Trimester
0–4 5–8 9–13 13–18 19–22 23–26 26–31

26–31 32–35 36–40
weeks weeks weeks
Changes
0–4
weeks
5–8
weeksin you
9–13
weeks
13–18
weeks
19–22
weeks
23–26
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26–31
weeks
32–35
32–35
weeks
weeks
36–40
weeks
You may:
■■ begin
0–4 to feel
5–8tired and uncomfortable
9–13 13–18 19–22 23–26 26–31 32–35 36–40
36–40
weeks
■■ have swelling in your feet, ankles
and hands
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■■ feel like your uterus is pushing on your
rib cage
■■ feel a little breathless

Your baby:
■■ is about 38 cm (15 inches) long
■■ weighs about 1 kg (2 lbs)
■■ moves a lot—others will be able to see
and feel your baby moving too Third trimester
■■ can sense light and sound
■■ can tell when you’re moving Your baby’s brain
■■ has formed billions of brain cells ■■ The outer part of your baby’s brain continues
to develop. The grooves and folds of their brain
■■ will start to suck their fingers
are formed.
and hands

0–4 5–8 9–13 13–18 19–22 23–26 26–31
26–31 32–35 36–40
weeks weeks weeks
Third Trimester
0–4 5–8 9–13 13–18 19–22 23–26 26–31 32–35

32–35 36–40
weeks weeks
Changes
0–4
weeks
5–8
weeksin you
9–13
weeks
13–18
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19–22
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23–26
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26–31
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36–40
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■■ sweat easily
■■ have a belly button that sticks out
■■ need to pass urine more often
■■ have sore joints as hormones are making your pelvic joints looser
■■ feel like you have to move more slowly and carefully
■■ look a little puffy and your feet, ankles and hands may swell

Your baby:
■■ weighs about 2.25–2.5 kg (5–5.5 lbs)
■■ is building up layers of fat under their skin to help keep them warm after birth
■■ is drawing on your immune system to develop immunity to some diseases. This helps
protect them during their first few months.
■■ is starting to lose the soft hair they had on their body
■■ is having rapid brain growth
“ When you feel that first kick, that's amazing.
~ Andy, expectant dad ”

0–4 5–8 9–13 13–18 19–22 23–26 26–31 32–35
32–35 36–40
weeks weeks
Third Trimester

0–4 5–8 9–13 13–18 19–22 23–26 26–31 32–35 36–40
36–40
weeks
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You may:
■■ be tired of being pregnant ■■ have varicose veins
■■ feel anxious about labour ■■ have the dark area around your nipples
■■ have Braxton-Hicks contractions that become larger and darker
happen more as you near your due date ■■ feel hot, heavy and uncomfortable
■■ have a back that aches more often ■■ feel faint or dizzy at times and a little
■■ be able to breathe more easily as your short of breath
baby moves down into your pelvic area ■■ have trouble sleeping
■■ have stretch marks ■■ get leg cramps more often
■■ have dry skin

Your baby:
Your baby’s movements
Healthy babies move 6 times in
■■ weighs 2.7–4 kg (6–9 lbs) 2 hours. You should feel regular
movements throughout the day,
■■ may be gaining 28 g (1 oz) a day
every day.
■■ usually has fully developed lungs that are
ready to breathe air
■■ is starting to store iron to use in their first 6 months
■■ will have skin that’s usually pinker and less wrinkled as they gain weight
■■ may scratch themselves with their fingernails
■■ has less room to move, so their movements will feel different

The best way to take care of your baby is to take care of yourself. These last few months of
pregnancy can seem very long. You may not be able to do the things you’re used to doing,
like tying your shoelaces. You may also find that you do not have much energy. This is
nature’s way of slowing you down and helping you save up energy for your baby’s birth.
Take time for yourself every day to

do the things you enjoy doing. Do
some gentle activity like walking,
gardening, snowshoeing or
swimming. Sit with your feet up to
relax or take a nap.
You’ll continue to gain weight

during your third trimester. Keep
track of your weight gain and talk
with your health care provider
about your weight gain goals (see
page 26).
During the third trimester, you’ll

only need about 450 extra calories
a day for a healthy weight gain.
Choose an extra 2–3 servings each
day from Canada’s Food Guide.
Keep taking your multivitamin
every day (see page 33).
“ ”
Resting was big, taking warm baths, eating well, and staying hydrated.
Knowing that it eventually ends was helpful, too!
~ Amanda, mom of one child

Physical activity helps your body stay healthy

and can help reduce the physical discomforts
you may be feeling. It can also help reduce the
stress and anxiety you may sometimes feel.
Being active can be as simple as going for a walk
every day. Physically active women tend to have
fewer symptoms such as backaches, swelling,
leg cramps and shortness of breath.
You can stay physically active as long as your

health care provider doesn’t have any concerns.
If you become uncomfortable, change what
you’re doing or reduce how long and how
intensely you do it (see page 44).
Your centre of gravity changes during pregnancy

and you may notice that you lose your balance
more easily. Watch your step, especially when
exercising and wear supportive footwear.
Things to keep in mind at this stage in

your pregnancy:
■■ Choose activities with a lower risk of falling,
like stationary biking, walking, swimming or
pool exercises.
■■ Stick with gentle stretches so you do not
overstretch or have pain.
Listen to your body and give yourself
Walk on
■■
permission to rest.
Keep walking on your own or
■■ Do not hold your breath at any time while with others—it’s good for you
you’re exercising. and your baby!
“ When I had discomforts the best thing was

to get some fresh air and go for a walk.
”
~ Thy, expectant mom

The third trimester brings more changes. Here are the reasons why and some ideas to help
you manage any of these discomforts.
Short of breath
Why?
Your growing baby takes up more room in your abdomen and presses on the flat muscle
that moves up and down when you breathe (diaphragm).

■■ Use good posture. ■■ Wear loose, comfortable clothes.
■■ Raise your head and shoulders ■■ Try eating small meals often.
when sleeping. Put a pillow under your
mattress to raise the head of your bed.
Trouble sleeping
Why?
You may not be able to find a comfortable
position.
You may be worrying about birth or parenting.
Your baby may be more active at night.
You may have heartburn (see page 151).
You may wake up at night to go to the bathroom.
Your uterus may be more active at night with
Braxton-Hicks contractions.

■■ Go for a walk outside in the daylight. This will set ■■ Share your worries with someone
your body’s inner clock and help you sleep. you trust.
■■ Try lying on your side and using extra pillows for ■■ Try coping strategies to reduce
comfort. Put a small pillow between your knees, your stress.
one behind your back and a small wedge pillow ■■ Take a warm bath (see page 80).
or folded towel under your abdomen.
■■ Try taking naps during the day.

Swollen hands, feet and ankles
Why?
There’s extra fluid in your body—your body makes more blood when you’re pregnant.
Your growing baby can put pressure on the blood vessels in your pelvis.

■■ Put your feet up as often as possible. ■■ Rest and try sleeping on your left side.
■■ Move around and try not to stay in one ■■ Wear loose clothing and comfortable shoes.
position for too long. ■■ Keep drinking lots of fluids, like water,
■■ Get up and stretch to improve blood flow. every day.
■■ Be physically active. ■■ Put on support stockings before you get
out of bed.
Heartburn
Why?
Changes in your hormone levels may slow food passing through your stomach and relax
the opening between the stomach and esophagus.
Your growing baby puts pressure on your stomach.

■■ Stay away from foods that upset your ■■ Drink liquids between meals, not with meals.
stomach. ■■ Use good posture to help with digestion.
■■ Eat or drink less caffeine, chocolate ■■ Try not to lie down for at least 2 hours after eating.
and high-fat foods.
■■ Sleep with your head and shoulders raised. Put
■■ Eat small meals more often. a pillow under your mattress to raise the head of
■■ Eat slowly and chew your food well. your bed
■■ Try chewing sugar-free gum. ■■ Do not take medicine for heartburn unless your
health care provider says it’s okay.
■■ Try not to eat or drink before bedtime,
except water. ■■ Wear loose, comfortable clothes.
“ I had really bad heartburn with all of my pregnancies and my best tip for that is
”
to eat really small meals all day long and then to stay upright for a while. I really
was hungry at bedtime but if I ate then I would have horrible heartburn.
~ Deka, mom of two children

Perineal massage
One of the ways you can prepare your body for labour and birth is to massage the area
between the vagina and anus (perineum), starting at 35 weeks. Massaging and stretching
the perineum 5 times a week may:
■■ soften and stretch the opening of the vagina
■■ decrease the need for an episiotomy if it’s your first vaginal birth
■■ prevent tearing of the tissue so you will not need stitches
■■ let you feel the same type of pressure or stretching that you’ll feel when you give birth
If you decide to do perineal massage, talk with your health care provider before you begin.
To learn more about perineal massage, visit the Links section at

Mental health
Your third trimester may bring about different
feelings. Having mixed emotions is common as
the reality of being a parent draws near. You may
be looking forward to the end of your pregnancy
so you can finally see and hold your baby and get
some relief if you’re having any discomforts. You
may also:
■■ worry about your health or your baby’s
well-being
■■ feel protective of your baby
■■ think and worry about labour and birth
■■ think of your own parents and how they
parented you
■■ think about life changes and having more It’s never too late
responsibility If alcohol, tobacco, cannabis or
■■ worry about upcoming maternity leave and other drugs are part of you and
your partner’s life, encourage
finances, or job-related responsibilities before
each other to cut down and quit.
you start maternity leave
■■ feel sad that the pregnancy is ending
episiotomy: a cut made through the perineum to make the vaginal opening bigger for the baby to be delivered

The time is getting closer for you too. You may find that you share some of the same
emotions, symptoms and behaviours as your partner.
While you may be excited about holding your baby for the first time, you may also be
worried about your partner’s and baby’s health, your role during labour and birth, and
having more responsibilities.
Other things you may be thinking about are when to go to the birth centre or cutting
the umbilical cord. Talk to each other and take the time to do things to relieve stress and
deal with your changing emotions.
Here are some things you can both do to relieve stress and deal with changing emotions:
■■ Talk about any fears that you may have ■■ Do something special just for you or with
with your partner. Talking about your your partner.
fears will not make them more real or ■■ Talk with other expectant parents.
likely to happen.
■■ Plan some special time with your partner
■■ Learn about pregnancy and parenting and your other children if you have them.
and go to prenatal classes.
■■ Drive to your birth centre together to
■■ Find support from family, friends and make sure you know how to get there
others in the community. and how long it will take.
■■ Practice installing the car seat.
Call Health Link at

811 or your health
care provider if you
! or your partner feels

depressed or anxious.
For more information
on symptoms, see
page 65.

Healthy sexuality
In the third trimester, it’s common to feel tired because you’re not sleeping as well. You
may also feel uncomfortable and bulky which can affect your sexual desire. The kinds of
things that excite and please both of you may also change. Trying different positions may
help you to find ones that are comfortable and pleasurable for both of you. You can try
lying on your side, being more upright, or sitting on top during sex. Tell each other what
you’re feeling, what works and what doesn’t work.
Prenatal Care
Prenatal checkups
Your health care provider will let you know how often they’d like to see you during the
third trimester. At these visits, your health care provider will usually:
■■ Check your weight and blood pressure. ■■ Listen to your baby’s heartbeat.
■■ Feel your baby through your abdomen. ■■ Check for swelling in your hands and feet.
■■ Measure your fundal height to check your ■■ Talk about your baby’s movements.
baby’s growth.
Your health care provider may also do a pelvic exam to see if your cervix has begun to thin
or open.
Routine tests
Your health care provider will want to do some routine tests and may recommend other
tests to check your health and your baby’s health. They will talk with you about these tests
and answer your questions.
Group B Streptococcus (Group B Strep)

When you’re 36 weeks pregnant, your health care provider will test you for a bacteria
known as Group B Strep. A swab of your vaginal and perineal area will be taken or you’ll
give a urine sample. Group B Strep is not an STI. For many women, this group of bacteria is
normal for their vagina and usually doesn’t cause them any problems.
However, if you test positive you can pass Group B Strep to your baby during labour. The
chance of a baby getting sick from you carrying a Group B Strep infection in your vagina
is very small, but it can make your baby very sick. You’ll be given antibiotics while you’re
in labour.

Assessing your baby’s well-being

Fetal movement count
You’ll be feeling your baby’s movements—stretches, kicks and rolls—every day. Some
babies are more active than others. All babies have times that they sleep and so they are
not as active. You’ll get to know your baby’s movements and routines. Counting your
baby’s movements is an easy way to tell your baby is doing well.
When you’re around 30 weeks pregnant, your health care provider may ask you to start
counting your baby’s movements and write them down. You’ll be given a chart and shown
how to fill it in.
A fetal movement count is the number of times you feel your baby move in 2 hours. You
should feel your baby move at least 6 times. If not, it can be a sign that they are not getting
enough oxygen through the placenta.
To do a fetal movement count:

Go to your birth centre
1. Count movements at the same time
NOW if you do not feel 6
!!
every day—pick a time when your baby is
movements in 2 hours or
usually active.
if you’re worried about
2. Get into a comfortable position lying on your a change in your baby’s
side or sitting. movements.
3. Place one or both of your hands on your
abdomen.
4. Count each time your baby moves.
5. Once your baby has moved 6 times, you can stop counting, even if it less than 2 hours.
Babies should not stop moving at the end of the pregnancy or when labour begins. Trust
your instincts. Go to your birth centre right away if you notice that your baby is not moving
as much or if your baby’s movements have changed. If you normally count 6 movements
within 30 minutes and then you notice that it’s taking two hours to record 6 movements,
that is a change in your baby’s movement pattern.

Fetal well-being ultrasound (biophysical profile)
This ultrasound may be done if your baby’s health needs to be checked or if there are
concerns about your pregnancy. It measures:
■■ your baby’s movements
■■ your baby’s breathing movements
■■ the muscle tone of your baby’s arms and legs
■■ the amount of amniotic fluid
Non-stress test (NST)

This test may be done if you’re past your due date or in the 1–2 months before your
due date if your health care provider has concerns about your pregnancy. To check your
baby’s health, a monitor is placed on your abdomen to monitor your baby’s heart rate
and movements. Babies are the same as us—their heartbeat goes up when they move or
are active.
Dental care
You can have dental treatments in the third
trimester. Your dentist will talk with you about
the risks and benefits. If you’re having dental
treatments, you’ll need to adjust how you sit in
the dental chair. If possible, lie on your side in the
chair or use a cushion to help you tilt on your left
side so your baby is not pressing on your back.
You may need to ask for a break during the dental
treatment. Practice good mouth care and have
your teeth cared for as needed.
Planning Ahead
There are many things you can do in the third trimester to get ready for labour and birth.
Now’s the time to learn about your birth centre, think about how you and your partner or
support person will get there, what supplies you’ll need to bring, and what to do when
you arrive.
It’s a good idea to get everything ready for the birth centre a few weeks before your due
date—as your baby could surprise you and come earlier than you think.

Start thinking about how you want to share the news of your new baby. You may need

to set limits when it comes to your family and friends. Instead of visiting you in the birth
centre, you may want to ask them to help by looking after your other children, pets and
animals, tidying your home or bringing over meals. Another way someone can help is to
be the person who passes on regular updates of the birthing process to the rest of your
family and friends.
Learn about your birth centre

Talk with your health care provider to find out when to go to the birth centre and what to
do when you get there. Ask how you register. It helps to know these things before you’re
in labour.
You may want to visit your birth centre ahead of time—this may be included in prenatal
classes. Your centre may also offer online or in-person tours. During a tour, you’ll see the
birthing rooms and you’ll learn what to expect when you’re admitted for your baby’s birth.
The visit may lower some of your worries about labour.
You may want to ask:

■■ if you can pre-register before you go into labour instead of registering when you arrive
at your birth centre in labour
■■ which door to use when you come to the birth centre and if you use the same door
during office hours and at night
■■ where to park
■■ what information you’ll need to bring with you for admitting
Ask your health care provider about your Prenatal Health Record if you haven’t been given
one yet. Most health care providers will give you a copy of your Prenatal Health Record by
36 weeks to bring to the birth centre. Others may send a copy directly to the birth centre.
If you’re given a copy of your Prenatal Health Record, you’ll need to bring it with you to the
birth centre so keep it with you. If you forget to bring it, your support person may be sent
home to pick it up.
Have the following registration information ready No latex balloons

ahead of time and take it with you to the birth centre: Latex balloons are not
allowed in birth centres.
■■ your Prenatal Health Record
They can cause severe
■■ your Alberta Personal Health Card allergic reactions in some
people and are a choking
■■ your Social Insurance Number
hazard for young children.
■■ the phone number of a relative or contact person

Planning with your labour support person
Plan for how you’ll stay in touch with your support person and get to the birth centre.
Arrange for the care of your other children, pets or animals if you have any. If you do not
have family or friends who can help you, think about hiring some help or accessing other
resources that may be in your community. It’s a good idea to have a backup plan if your
support person can’t come with you. In case you need to call a friend, neighbour or taxi,
know their phone numbers and keep them available. If you need to take a taxi or use
ride-sharing, have money set aside to pay for it.
If your support person works or

doesn’t live with you, talk about a Birth ball
plan on how to reach each other by It’s a good idea to practice sitting on a birth ball
phone or text. You can ask them to at home before you’re in labour. Make sure:
phone you at regular times during ■ it can hold your weight
the day if they will be hard to reach. ■ you have someone supporting you or have
Plan how you’ll stay in touch with something stable in front of you to hold onto
your backup support person too.
Make sure you and your partner or support person know:

■■ what birth centre you’re
going to If you’re a partner
■■ how to get there Every pregnant woman in labour needs support.
They need you to be there for them—their job
■■ how long it takes to get there is hard. With you there, it will be easier. You can
■■ where to park your car offer encouragement, comfort and help.
“ ”
The best thing will be having my husband with me. I have told him that he has to
keep a smile on his face and tell me I am doing well!
~ Mahalia, expectant mom new to Canada
You’ll also want to plan ahead for what you want to do when you come home with your
baby. You’ll probably feel tired and will want to spend lot’s of time with your new baby. Tell
your friends and family what they can do to help. Think about when and for how long they
can visit. Ask for support so that your new family can have some time to bond with your
baby and get to know one another in the first few months.

Packing for the birth centre

Even though you may only be in your birth centre for 1 or 2 days, you’ll need to bring
supplies for both you and your baby. Here’s a list to get you started. It’s best to leave any
valuables like cash and jewellery at home.
Packing list for the birth centre

For you For your baby
❑ your birth wishes ❑ 1–2 receiving blankets
❑ Alberta Personal Health Card and other ❑ 1–2 undershirts
insurance cards ❑ 1–2 sleepers
❑ your Prenatal Health Record—if given to ❑ 1 package of newborn diapers
you by your health care provider
❑ 1 hat
❑ housecoat, slippers, pyjamas or other
❑ laundry bag or plastic bag for
comfortable clothing—many women
dirty clothing
choose to wear the hospital gowns
❑ baby clothes for going home
❑ 3 pairs of maternity underwear
❑ rear-facing car seat
❑ 2 nursing bras
❑ unscented lotion, toothbrush, Other labour comfort supplies
toothpaste, deodorant and shampoo ❑ lip balm or mouth spray
❑ 1 package of long feminine pads for ❑ sugar-free mints or hard candies to keep
heavier flows your mouth moist
❑ cell phone and charger, or coins for the ❑ something to focus on like a picture
pay phone and any phone numbers you
❑ music—electronics and a charger
may need
❑ massage tools such as a tennis ball,
❑ loose-fitting clothing to wear home— unscented oils or lotions
you’ll probably still be wearing your
maternity clothes ❑ extra pillows—with bright or patterned
pillow cases, so they do not get mixed
❑ black pen to fill out forms up with the hospital ones
❑ a water bottle with your name on it ❑ birth ball—if you plan to use one
❑ your copy of this book ❑ warm socks and slippers or comfortable
❑ your blood glucose monitor if you shoes
have one
❑ camera—ask permission from
If you’re a partner or support person health care providers before taking
❑ change of clothes, comfortable footwear their picture
❑ bathing suit to give support in the ❑ a list of comfort techniques that you
shower want to use
❑ toothbrush, toothpaste, deodorant and
other personal supplies
❑ drinks and snacks for both of you—you
may not be able to leave to go get food

While-you-wait checklist
In the last few weeks of pregnancy, you can use this list to help you get ready to go to
the birth centre and for after the baby is born:
❑ Pack for the birth centre. ❑ Make sure you have long feminine
pads and breast pads.
❑ Stock up on basic foods for when you
come home. ❑ Practice the breathing and relaxation
exercises in this book or that you may

❑ Cook larger meals and freeze the
extra servings. have learned in prenatal classes.

❑ Do your pelvic floor muscle exercises

❑ Check your baby supplies and get any
missing items (see page 130). and other activities, unless your

health care provider has told you
otherwise.

You may have many questions about how you’ll care for more than one baby at a time.
Here are some things you can do now to help you get ready:
■■ Talk with your partner or support person about your concerns. One person might be
thinking about feeding, while the other may be more focused on expenses. You can
plan better if you share your ideas with each other ahead of time.
■■ Start planning as soon as you find out you’re having more than one baby, as your babies
may be born early. Get as much done as you can ahead of time.
■■ Ask your friends and family to help when you come home from the birth centre. Let
them know what you’ll need help with.
■■ If you’ll be parenting alone, talk with your support people. You’ll appreciate the help
once your babies arrive.
■■ It may be helpful to join a support group for parents of twins, triplets and more.
■■ Learn more about breastfeeding more than one baby, talk with other parents or your
health care provider.
“ ”
There are good days and there are bad days but the key is to stay positive and
to support one another.
~ Mike, expectant dad of twins

If Pregnancy Doesn’t Go as Expected

Sometimes pregnancy doesn’t go as expected, which may make you feel angry, scared or
disappointed. Here is some information that can help you understand what is going on.
If you go past your due date

Every pregnancy is different—not all babies arrive before the end of the 40th week. If
you go past your estimated due date, it may be because your baby needs more time or
because the estimated start date of your pregnancy was wrong.
If your pregnancy goes past 41 weeks, your health care provider may send you for an
ultrasound or fetal monitoring to make sure everything is okay. If needed, your labour
may be started by medical means (induced). For more information on inducing labour,
see page 197.
High blood pressure

Call Health Link at 811 or your
High blood pressure during
pregnancy can cause serious
health care provider, if you have
problems, like pre-eclampsia. Your any of the following:
health care provider will check your ■■ a bad headache that is unusual,
blood pressure at every visit. very bad, or doesn’t go away
Preterm labour
Preterm (premature) labour is labour
! ■■
■■
sudden swelling on your hands
and face
blurred vision
that starts between 20–37 weeks of ■■ a very bad pain under your rib
pregnancy. If you go into preterm cage or the right side of your back
labour, your health care provider may ■■ sudden, unexplained nausea and
try to stop the labour. This is to give
vomiting
your baby a chance to develop more
before birth.
Know the signs of preterm labour and to trust your instincts. If you think something’s
wrong, call your health care provider or go to your birth centre—it can make a big
difference to your baby’s health. For more information about preterm labour, see page 138.
fetal monitoring: using a machine to check your baby’s heart rate

Call Health Link at 811 or your health care provider NOW if you notice
any signs that could be preterm labour:
■■ contractions that may or may ■ a change in or more vaginal
not hurt discharge
■■ abdominal cramps, that may feel ■ discharge that smells bad or that
!
like menstrual cramps or gas pains is not white or clear
■■ diarrhea ■ pressure in the pelvis or lower
■■ a change in lower back pain abdomen
■■ fluid gushing or leaking from

■ a full or heavy feeling in
the vagina the vagina
■■ spotting or bleeding from

the vagina
Cord prolapse
Cord prolapse is when the umbilical cord
!!
falls from the uterus into the vagina before Call 911 NOW if your
the baby and disrupts the blood flow to the water breaks and you feel
baby. This happens very rarely, however, it’s something in your vagina.
an emergency for your baby if it does.
If you feel something in your vagina and your water breaks—this may be a sign of cord
prolapse. You may feel an urge to push, if you have a lot of pressure in your rectum or you
can’t stop yourself from pushing with contractions. You need to:
■■ Get on your hands and knees.
■■ Put your forehead on the floor and point your buttocks to the ceiling.
Placental abruption Call 911 NOW if you have any of the

A placental abruption is when the following:
placenta separates from the wall
!!
■■ moderate to severe pain in your
of the uterus. You may or may abdomen that doesn’t stop
not have any bleeding when the
placenta separates.
■■ severe vaginal bleeding—soaking
1 thick feminine pad or more in
1 hour, for 2 hours in a row

Labour & Birth:
The Big Event
Photo courtesy of the United States Breastfeeding Committee 163

Labour & Birth: The Big Event
This is it! You and your baby have been getting ready for this moment
for quite some time. Knowing what to expect and trusting your body will
help build your confidence and prepare you for this amazing experience.
In this chapter, you’ll learn about the process of labour and birth, ways
to work with your body’s natural instincts, and many helpful coping and
comfort strategies.
Photo above reproduced with permission from Eckstein, K. (2013).
164
Knowing What to Expect
LABOUR & BIRTH: THE BIG EVENT

What will your labour and
the birth of your baby be
like? It’s hard to say. While the
physical process of giving
birth may be similar for most
women, the experience and
emotions that you’ll feel are
unique. Even if you’ve given
birth before, chances are
this birth experience will be
different from the last time.
Your body
knows what to do
When thinking about labour and birth, it’s common to be excited to meet your new baby.
You may wonder, “Can I do this?”—yes you can! Learning more about your body can help
you through labour. Take a moment to think about all the things your body is doing right
now to support your baby during pregnancy, without you needing to even think about it.
Labour and birth are similar.
Your body is preparing for labour

Your body has been preparing for labour
for many months now. Hormones have A massage can help
been softening ligaments to help your Did you know that a massage can help
baby get through your pelvis. They also increase a pregnant woman’s endorphin
give you the energy you’ll need to meet levels to prepare them for labour?
the challenges of labour and birth.
Your body normally makes chemicals called endorphins. One of the things endorphins do
is reduce pain. To prepare for labour and birth, your body makes more endorphins than
usual in the last few weeks of pregnancy. By the time you’re ready to give birth, your body
has 10–30 times its normal levels of endorphins. For many women, these endorphins have
a calming effect too. Your support person may be able to see the endorphins take effect
during labour—you may become groggy and even lightly sleep between contractions.
endorphins: hormones that relieve pain and cause feelings of intense happiness

Signs that your body is getting ready for labour
Your body may let you know it’s getting ready for labour a few days, or even weeks, before
labour begins. Here are some signs you may notice:
■■ Lightening: your baby ‘drops’ or settles into your pelvis. This can happen up to 4 weeks
before labour starts. When your baby drops, you may find it easier to breathe. You may
also pass urine more often, as there will be extra pressure on your bladder.
■■ Irregular contractions: you may have Braxton-Hicks contractions. These practice
contractions help to soften your cervix and prepare your uterus for labour. You may feel
these contractions as irregular tightening in your abdomen for days or weeks before
your due date. Sometimes, close to your due date, these contractions may become
regular, making you wonder if labour has started. Practice contractions do not become
longer, stronger and closer together over time. They stop after a few hours.
■ Your cervix begins to soften (ripening): Hormones called prostaglandins help to
soften your cervix. You’ll know this is happening by these signs:
Mucous plug: during pregnancy your cervix is closed tightly. Mucous collects in the
cervix and forms a plug at the centre. As your cervix begins to soften, the mucous plug
is released. Your mucous plug may come out all at once or in pieces. It’s a sign that your
body is getting ready for labour, but not a sign that active labour will begin right away.
It may be days or weeks before active labour begins.
Bloody show: as your cervix softens, thins and opens up, small blood vessels break,
which can make the mucous pink or red. This shows that your body is getting ready for
labour.
■■ Soft bowel movements: the hormone that causes your uterus to contract also works
on your bowels, so you may notice loose stools or diarrhea. Talk with your health care
provider if you’re concerned about these symptoms or if they last longer than 24 hours.
■ Gush or trickle of fluid from your vagina: this usually means that your ‘water has
broken’ (ruptured membranes). If this
happens before labour starts, go to your
Call Health Link at 811 or
!
birth centre—even if you’re not having
your health care provider if
contractions. The risk of infection goes
up when your water breaks because you’re not sure if your water
the protective seal around your baby is has broken.
no longer there to prevent germs from
reaching them.
active labour: contractions are more regular, intense and your cervix will dilate

Nesting: a burst of energy and the need to have everything ready for your baby’s arrival.

■■
Nesting may happen a few days before labour starts. Be careful not to get too tired.
You’ll want to save your energy for labour and birth.
■■ Backache: backaches are common later in pregnancy. Massage, moving around and
using heat, like taking a shower, will often help you feel better. If the backache comes
and goes in a pattern, you’re probably having contractions.
Labour pain has a purpose

Wondering about the pain of labour is normal. It can help to look at the pain of labour as
a positive type of pain. Pain is your body’s way of telling you something. Most of the time
pain tells you that you’re hurt. However, labour pain is different. Labour pain tells you that
it’s time to begin bringing your baby into the world.
You’ll notice that some positions and movements in labour lessen your pain. These
positions and movements are the ones that will help your baby to tuck, turn and move
through the pelvis.
Your body already has the energy, the strength

and the ability to reduce pain to get you through Preterm labour
a normal labour and birth. To help your body do Signs of labour before 37 weeks
its job, change positions often. You may feel more are signs of preterm labour. For
pain for a moment when you do this. Try to stay more information, see page 139.
calm and focused. For information on other pain
relief options, see page 193.
You’ll feel more confident by practicing coping skills, learning what to expect by taking
prenatal classes and reading this book. Once you’re in labour:
■■ Stimulate your senses—music, warmth, touch and focal points can reduce the number
of pain signals you feel.
■■ Take advantage of the increased release of endorphins with massage—especially of
your feet and hands.
■■ Get into the shower—many women find the shower helps them stay calm, focused and
feel less pain.
■■ Sit in a bathtub if your birth centre has one, and as long as your membranes haven’t
ruptured—a bath can help release tension and relax muscles.
■■ Remember to drink fluids and empty your bladder about every 2 hours.

Stopping the fear-tension-pain cycle
When you’re afraid, your body releases high levels of stress
hormones that work against your body, make you tense, and Fear
use up your energy. This can lead to a longer and more painful
labour. If you use relaxation strategies that decrease the tension,
Tens
you can break this fear-tension-pain cycle.
Pai
Use strategies that keep you relaxed and focused (see page 183).
n ion
This will help you work with your body and keep your pain levels
under control. Remember—your body knows what to do.
What are contractions like?

It may be helpful to imagine contractions as waves that build, peak and fade. As labour
progresses, the contractions become stronger, longer and closer together. At first, the
contractions may feel like menstrual cramps. Later you may feel them in your lower back
and even inner thighs.
As labour progresses, the contractions will take more of your focus and energy—
eventually you won’t be able to walk or talk through them. Cope with your contractions by:
■■ using your support person to help you stay calm and focused
■■ moving and changing positions
■■ using strategies to keep you comfortable, calm and focused
Contracting uterus
Contractions gradually
push the baby’s head
into the cervix
Dilating (opening) and effacing (thinning)

Bulging Contractions and the pressure of the
amniotic sac baby’s head dilate and efface the cervix

When to go to your birth centre

“
You’ll most likely begin labour somewhere between
38–42 weeks, 1–2 weeks before or after your I thought I was in labour
estimated due date. so many times, but when
real labour happens the
It’s usually safe to stay at home until active labour is
”
timing and intensity—
well underway. Staying at home helps with coping
you can’t miss it!
and the progress of labour. Depending on where you
live and the weather conditions, you may need to ~ Maggie, mom of a newborn
leave for the birth centre sooner. Ask your health care
provider when you should go to the birth centre.
Most health care providers say you need to go to

your birth centre when:
■■ contractions are becoming stronger, you’re no
longer comfortable at home, and
if you’re having your first baby, contractions
have been 5 minutes apart for 1 hour and last
about 1 minute each
if this is not your first baby, contractions have
been 7–10 minutes apart for 1 hour
■■ you’re leaking fluid from your vagina (your
membranes may be ruptured)
■■ if you notice your baby is not moving as much
or your baby’s movements have changed
Call 911 NOW if you have any of the following:

■■ moderate to severe pain in your abdomen that doesn’t stop
■■ severe vaginal bleeding—soaking 1 thick feminine pad or more in 1
hour, for 2 hours in a row
!! ■■
■■
you have a lot of pressure in your rectum, you can’t stop yourself from
pushing with contractions, or you have the urge to push
you feel something in your vagina and your water breaks—this may be
a sign of cord prolapse. If so, you need to:
get on your hands and knees
put your forehead on the floor and point your buttocks to the ceiling

How to time your contractions
You’ll want to time how often you’re having a contraction and how long it lasts. To time
your contractions:
■■ time from the beginning of 1 contraction to the beginning of the next—how often they
happen (frequency)
■■ time from the beginning to the end of 1 contraction—how long they last (duration)
Contraction Period of relaxation Contraction
Beginning End Beginning End
Duration
Frequency
At the birth centre

Once you’re settled at the birth centre, a health care provider will review your Prenatal
Health Record, examine you, and ask more questions about your pregnancy and labour.
This is also a good time to talk about your birth wishes.
In the physical exam, a health care provider will:

■■ Check your pulse, blood pressure and ■■ Listen to your baby’s heartbeat.
temperature. ■■ Assess how often you’re having contrac-
■■ Press on your abdomen to check your tions and how strong they are.
baby’s position. ■■ Ask you questions about your medical
■■ If needed, check how far your cervix has and prenatal history.
thinned and opened by inserting gloved ■■ Ask you who your support people are.
fingers into your vagina.

What happens during labour and birth

The work your body does to give birth to your baby (labour) is a process that has three
stages. It usually begins slowly and ends with the birth of your baby and delivery of your
placenta. Labour can last anywhere from a few hours to 24 hours or more.
Every pregnancy is different. If this is your second or third baby, labour will probably be
shorter than it was the first time—but not always. How long labour lasts depends on many
things including your baby’s position, how strong
your contractions are, and your general health.
During the first stage of labour, contractions will:

■■ thin the cervix (effacement). Contractions
will soften and thin out the cervix, which helps
it to dilate so your baby can move out of your
uterus.
■■ open the cervix (dilation). Contractions will
open your cervix until it’s fully dilated to 10 cm,
which helps your baby move out of your uterus.
To find the best position to move through your pelvis, your baby needs to tuck their
chin into their chest. They may also turn to face your back (anterior position). Moving
and changing positions while you’re in labour helps your baby tuck and turn. Labour
contractions and pushing during the second stage will help your baby move through the
pelvis and vagina before birth.
Three Stages of Labour

There are 3 stages of labour:
■■ First stage: is when your uterus starts to contract and then relax. These contractions
help to thin and open your cervix. There are 3 phases to the first stage:
Phase 1: Early (latent) labour
Phase 2: Active labour
Phase 3: Transition
■■ Second stage: begins when your cervix has thinned and is fully dilated. It includes
pushing, and ends with the birth of your baby.
■■ Third stage: is the delivery of your placenta.

First Stage of Labour: Contractions,
Thinning and Opening of the Cervix
A thick cervix helps hold your baby inside your uterus while they grow. For your baby to
be born, your cervix has to become thin and has to open wide enough for your baby to
pass through.
Cervix is thick and closed Cervix is open about 2 cm Cervix is thinning and
open to about 6 cm
Your uterus is a large muscle and like any muscle, when it contracts, the whole thing
contracts. The contractions begin at the top of your uterus and spread across it like a wave.
In the first stage of labour though, you’ll often feel the contractions only in your lower
abdomen and lower back even though your entire uterus is contracting. Contractions thin
and open the cervix by pulling up on it.

First stage, phase 1: Early (latent) labour

Early labour is the first, and usually the easiest and longest phase. Your cervix begins to
dilate and thin in this phase. This phase usually starts very slowly, giving you time to get
used to the sensation and rhythm of labour. At the start of early labour, the contractions
are mild, short and irregular. Your contractions may come every 20–25 minutes (frequency),
last 30–45 seconds (duration) and be mild to moderately strong. Your normal activities
probably won’t be affected very much. As labour progresses, the contractions become
stronger, longer and more regular.
Physical changes
The hormone connection
As your cervix dilates, you’ll notice your vaginal
Oxytocin is the hormone that
discharge is light pink. This is normal. As the
makes your body create the
levels of labour hormones go up, you may also contractions. Staying calm,
find you have several loose bowel movements. focusing and using comfort
measures can help your body keep
Emotions up your level of oxytocin, which
will help your labour progress.
You’ll probably feel many emotions from
excitement to nervousness.
Coping, comfort and self-care

During this phase, you can help your body cope and stay comfortable by:
■■ eating small amounts of food that are easily digested such as soup, crackers, toast or fruit
■■ staying hydrated and maintaining your
energy by drinking enough fluids, such If you’re a partner
as water, juice or other clear fluids, or by ■■ Encourage your laboring partner
sucking on ice chips to rest
■■ balancing activity with rest ■■ Help with distraction
■■ having your labour support person be ■■ Be sure the transportation to the
with you birthing centre is ready
■■ Be sure the bags are all packed
■■ ignoring your contractions for as long as
for the birthing centre
you can by doing whatever helps distract
you, such as sleeping, playing games, ■■ Keep up your food and fluid level
going for walks or watching movies ■■ Start your plans for child care
for your other children, pets, or
■■ emptying your bladder every 2 hours or so
animals

First stage, phase 2: Active labour
Active labour is marked by an increase in contractions. The contractions vary widely in
how long they are. Contractions often come every 2–3 minutes, last 45–75 seconds and
will be moderate to strong.
Physical changes
The pink-tinged vaginal discharge continues. Your cervix will continue to dilate. Your water
may also break during this phase, if it hasn’t already.
Emotions
You’ll continue to feel many different emotions that may get stronger as your labour
continues. It’s normal to wonder how long your labour will last and what the rest of your
labour is going to be like. It’s also common to lose focus at certain points during labour,
especially if you’re moving from your home to your birth centre, if there’s a change in your
health care provider, or as your labour begins to move to the next phase.

Some tips to help you through this phase are to:
“
■■ Keep drinking clear fluids to keep up
your energy and stay hydrated. During prenatal classes [my
■■ Listen to your body, it knows what to do. husband] learned a lot about
Do whatever helps your body do its job. massaging, breathing and
■■ Focus only on the contraction you’re calming me down. What is going
having and then let it go. to be huge is the support from
”
him verbally, physically helping
■■ Tell your labour support person what
you need to stay calm and focused. me through.
■■ Use upright positions that make use ~ Mylene, expectant mom
of gravity and let you rock and sway
your pelvis.

First stage, phase 3: Transition

Transition is the most intense and shortest phase of labour. During transition, you’ll have
strong contractions that may come every 1–2 minutes, with almost no break between
them. These strong contractions will each last around 60–90 seconds.
Physical changes
Your body is working very hard during this transition phase. It’s common to have many
physical changes, such as nausea, sweating, shaking and pink-tinged mucous. Your baby
will begin moving down into the pelvis. At this point, you may feel pressure in your
rectum—like you need to have a bowel movement. You may start to feel the urge to push.
Your health care provider will suggest ways for you not to push until your cervix is fully
dilated. This is important, since waiting until your cervix is fully dilated will help prevent
your cervix from swelling.
Emotions
It’s common to feel afraid, nervous and dependent on those around you. You may want
labour to stop. You may feel overwhelmed or want to give up. Your body is working so
hard that you may feel like you’re losing control. All of these feelings are a normal part
of labour.

Your body knows what to do during this intense phase. Your endorphins, the chemicals
that help relieve pain, are at their highest. Many women feel sleepy or enter a different
state of mind because of these chemicals.
A labour support person provides ongoing physical and emotional support. Her needs
may change during labour. Ask her what would be helpful, such as:
■■ putting a cool cloth on her forehead
■■ offering ice chips between contractions
■■ looking your partner in the eyes and helping to breathe with her through each
contraction
■■ talking or keeping the room quiet
Know and accept that your partner may become irritable or act differently. Say how
proud you are and that it’s almost time to meet your baby. You may need to repeat this
a lot! Ask the health care providers for suggestions of other ways you can help.

Working with your body during labour
The most important job you have in labour is doing whatever it takes to help your body do
its job. The following may help:
■■ Stay active: for your baby to travel through the pelvis better, you need to keep your
hips moving. Swaying, rocking, and walking helps move your baby down and out. Try to
change positions every 30 minutes or so.
■■ Listen to your body: your body will tell you what it needs. Rest when you need to rest.
Drink when you need to drink. Make noise if it helps you feel better. Choose positions
that feel most comfortable to you.
■■ Surround yourself with people who will support you, respect you and make you
feel cared for: support during labour can help you cope better, reduce your need for
pain medicine, and may help you have a shorter labour and a vaginal birth. One or more
people should stay with you throughout labour and birth. They can ask you what your
preferences are as these may change throughout your labour.
■■ Release muscle tension: tense muscles use
up energy that your uterus needs. Try to focus Be open to what works
on keeping your jaw, shoulders, arms and legs for you in the moment
relaxed. Your support person can help you Asking questions and getting
remember to do this. answers will help relieve your
fears and concerns.
■■ Make your labour environment safe and
private: this will help you stay calm and focused.
■■ Stay flexible: labour is a journey. Stay flexible and let yourself adapt to your labour
pattern to help you feel less stress and cope better.
■■ Meet your body’s basic needs: balance moving with rest. Drink plenty of fluids.
Remember to breathe—your uterus and your baby need oxygen to do their jobs.
■■ Make room for your baby: make sure you give your baby as much room as possible
by emptying your bladder every 2 hours or so. You can also help widen your pelvis by
using shallow lunging and squatting positions and only with support from your labour
support person. A birth ball can also be used to sit on in order to rock and rotate your
pelvis. This will help your baby move down into your pelvis.
■■ Let gravity do some of the work for you: your baby will move more easily down into
your pelvis if you choose upright positions, such as standing and leaning.
■■ Let your hormones work with you: for contractions to do their job, they need the
ongoing release of the hormone oxytocin. Touch and massage help to release oxytocin.

Stay calm and focused: it’s normal to feel stressed during labour. Being afraid, feeling

■■
panic and tensing your muscles causes high levels of stress hormones to be released,
which can decrease oxygen to your uterus. This can lead to more pain, contractions that
are not as effective, a slower labour and less blood flow to your baby. Contractions are
more effective when you’re calm and focused. Try to break the fear-tension-pain cycle
(see page 168).
Positions for labour

Trying different positions and moving
during labour can help to reduce your
pain and help your labour progress. At the
beginning of labour, most babies enter the
mom’s pelvis looking to the side. Your baby
needs to tuck their chin into their chest and
find the best position to move through the
pelvis. They may also turn to face your back
(anterior position).
When you choose positions such as

standing, leaning, or sitting on a birth
ball, you’re using gravity to help your
baby move down through your pelvis.
This makes it easier for your body during
labour. When you do these positions with
movements such as walking, swaying, rocking, or shallow lunges with support from your
partner, you’re helping your baby make the tucks and turns they need to enter and move
through the pelvis.
A birth ball can also be used to sit on in

order to rock and rotate your pelvis. This Birth ball safety
will help your baby move down into the Your health care provider will help you
pelvis. It’s a good idea to practice sitting on use a birth ball safely. If you’re using a
birth ball at home, make sure:
a birth ball at home before you’re in labour.
■■ it can hold your weight
■■ you have someone supporting you or
have something stable in front of you
to hold onto

“
Women are naturally restless during labour.
Women may think labour
You’ll instinctively move, sway and pace. Here
are some things that might help:
happens on your back, but it
”
happens in whatever position
■■ Choose the position and movements that feels good at the time.
feel right to you at the time.
■■ Try to change positions at least every ~ Robin, mom of a baby
30 minutes.
■■ Use mostly upright positions, such as standing, walking, leaning or slow swaying with
your partner.
■■ Balance activity with rest. Alternate upright positions with more restful positions. Try
sitting on a birth ball, sitting in a chair, sitting forwards or even backwards, or laying on
your side for a short time.
■■ Avoid spending too much time in positions that prevent you from moving your hips, like
lying in only one position in bed.
There are times when a woman may need to stay in bed during labour. If this happens:
■■ Ask if you can switch between lying on each side, lying almost on your abdomen, and
lying on your back with a tilt.
■■ Try to change positions every 20–30 minutes.
Your movements and positioning will help your labour progress. Sometimes though, your
baby’s head may have trouble moving through your pelvis. If this happens, your health
care providers may recommend options to assist with the birth, such as a caesarean birth.
For more information on caesarean birth, see page 201.
Walking and standing

Standing and walking can help during the early and
active phases of labour. This lets gravity do more of the
work, as it:
■■ helps your baby move down into position for birth
■■ may help relieve backaches
■■ makes your contractions more regular
Standing can be tiring, so you can also rock and sway

your hips. You may find it easier to lean forward over
something or someone.

Sitting upright

Sitting during labour uses gravity to improve your contrac-
tions. It’s also a good resting position. You can make this
position even more restful by leaning on the bed or your
partner. You can have your back rubbed at the same time.
Sitting on a birth ball gives you the benefits of sitting while

still being able to move your hips. Sometimes though, sitting
too long can make backaches and hemorrhoids worse.
Kneeling on all fours

Kneeling on your hands and knees (all fours) for short
periods can help in early and active labour. This can:
■■ relieve backaches—especially if you sway your hips or do
a pelvic tilt at the same time
■■ help turn a baby who is facing front instead of back
■■ take the pressure off of hemorrhoids—if you have them
To ease the pressure on your wrists, try leaning on your

forearms. You can also do this with a birth ball or a low
chair—have your partner or labour support person hold the
ball so that it doesn’t roll away from you.
How to do a pelvic tilt

1. Kneel on the floor or bed on your hands and knees, with your back flat.
2. Lift the centre of your back up towards the ceiling as if a rope is pulling the middle of
your back up. Drop your head down as your back curls upwards.
3. Relax and return your back to the flat position. Repeat several times, moving slowly
and rhythmically. Remember to breathe.
pelvic tilt: when the front of the pelvis rises and the back of the pelvis drops

Lying on your side
Lying on your side in early and active labour is a good resting position to alternate with
walking. You can combine this position with a pelvic tilt to:
■■ ease contractions
■■ relieve backaches
■■ help you relax between
contractions
Try pulling your knees

up and placing a pillow
between them. You can
also keep your lower leg straight, bend your top knee and rest it on a pillow with your
knee closer to the mattress. This opens the tailbone area of your pelvis for your baby to
move into. Reaching your arms up towards the headboard can also make more room for
your baby.
Squatting
Squatting widens the pelvic outlet and makes it
easier for your baby to move through your pelvis.
Squatting can tire you out, so you may only want
to do it after your baby has entered the pelvis or
during pushing—this position doesn’t help your
labour before then. Other squatting positions that
can help include:
■■ sitting on the toilet
■■ sitting on a low stool
■■ using a squat bar on the birthing bed
pelvic outlet: the bony ring that your baby will pass through

When you have back labour

Feeling contraction pains in the back often happens in any labour. It’s more common
if you baby is head down but facing the front of your pelvis (posterior position) instead
of being chin-tucked and facing your back (anterior position). This may cause you to
feel extra pressure and pain on your back—either all the time or sometimes during
contractions only.
Posterior position Anterior position
Labour may be slower and hurt more when your baby is in a posterior position. This
position puts pressure on your bones and ligaments, which causes more pain. Your baby
also doesn’t fit as well through the pelvis in this position, which leads to a longer labour.
Before they’re born, most babies in a posterior position will move into an anterior position.
Often a baby will rotate their head during the second stage of labour, while you’re pushing.

Your baby’s head usually fits through the pelvis better when in the anterior position.
However, you can also give birth to your baby if they are in the posterior position.
Doing a pelvic tilt slowly and rhythmically will help during back labour. Pelvic tilts support
the lower back, eases back discomfort and help make the pelvic outlet larger. They also
encourage your baby to turn if they’re in the posterior position (see page 179).
Tips to help with back labour
Strategy Tips
Positioning ■■ Lean forward, stand or sway.
■■ Change your position often—kneel on all fours, lie on your side with your top
leg on a pillow or sit on a birth ball.
■■ Use positions that open your pelvis, such as stair climbing or squatting.
■■ Put one leg up on a low footstool and do shallow lunge with support during
the contractions to help turn your baby.
■■ Do not squat during early labour—squat only after your baby has entered the
pelvis or during pushing.
Movement ■■ Walk or move your hips side to side.
Massage or ■■ Use a deep, steady pressure or

pressure circular massage.
■■ Your support person can put
pressure on your lower back area
using a hand or fist, tennis ball or
rolling pin.
Heat or cold ■■ In the shower, have your support person hold the spray nozzle on your
lower back.
■■ Put an ice pack wrapped in a cloth on your lower back.
“ I found walking around as much as I could, finding a focus object on the wall
”
in the room and having a good coach was helpful. My husband and my mom
were there.
~ Lorna, mom of a toddler

Ways to stay relaxed

There are many ways to help you relax. You may
want to practice different ways before you go
into labour. Your support person can help by
encouraging you and giving you emotional and
physical support. The best type of relaxation is
whatever works for you.
Music and relaxation recordings

Bring music with you if you find music soothing.
Recorded relaxation sounds or listening to a
recorded book may also help.
Focal point
During contractions, focus your attention to help keep your breathing regular and help
you stay as relaxed as possible. To focus, concentrate on something other than the pain of
labour, like something:
■■ you can see—a person or object in the room or your baby’s ultrasound picture
■■ you can hear—your support person’s voice, your own breathing or the clock ticking
■■ happening inside your body—your cervix opening
You may want to change your focal point several times during labour.
Creative imagery
A soothing memory or picture can also help you stay calm. Do you have a favourite place
you like to visit or a place you’d like to go one day? By imagining yourself there and using
your senses to make a picture, you’ll focus less on the pain of labour. Imagine yourself:
■■ sitting by a beautiful pond, throwing pebbles into it. Count all the ripples on the water
as each pebble hits.
■■ in a swing, holding your baby in your arms. Feel the warmth of your baby. Count as
you swing.
■■ as a tree in the wind, bending with the force of the breeze as you go with the force of
your contraction. Come upright as the wind and your contraction subsides.

Massage
Many types of massage can help because they increase
your endorphin levels. Self-massage or massage from
your support person can help release tension. You
can try:
■■ light, rhythmic, circular stroking of your abdomen
(effleurage)
■■ gentle muscle massage of your shoulders, back, legs
or feet
■■ deep, steady pressure or circular massage with fists or
heels of the hands on your lower back—this helps if
you have back labour
■■ firm, long strokes down your arms or thighs in time with your breathing
■■ temple and head massage
Water therapy
Once you’re in active labour, a shower may help, or a
warm bath if your membranes haven’t ruptured. You
may find it comforting to have warm water run over
your back or abdomen while you’re sitting or standing
in the shower. A relaxing shower also helps you stay
upright and may help you to refocus.
Warm water bottles or washcloths on your lower back

can be a comfort. Some women find that cold packs or
ice wrapped in a towel can also help.
Reproduced with permission from Chadwick,
originally posted on Bloom.ca. (2013).
Calming breathing patterns
Breathing patterns can help make your labour easier. It can be a focus and a distraction—it
helps you relax and it prevents you from pushing too soon. Using breathing techniques
can also increase the amount of oxygen your baby gets. If you hold your breath, your
muscles tense and cause more pain.
Steady, slow, relaxed rhythmic breathing helps to calm your body and mind. It may give
you a sense of control or a feeling of letting go. Breathing patterns can help you, your
baby, your support person and your health care providers during labour by:
■■ helping your body stay relaxed

giving your baby lots of oxygen during contractions

■■
■■ letting your support person know that a contraction is starting or ending, so they know
when to help you
■■ letting everyone in the room know that a contraction is beginning
While there are no rules about how to breathe during labour, here are some ideas about
how you and your support person can work together. You may not need to focus on
your breathing at the start of labour; however, most women find that calming breathing
patterns help once their contractions become stronger.
Progressive relaxation
Progressive relaxation is one way you can relax your muscles as much as possible.
1. Make your space comfortable—warm, peaceful and safe with no distractions.

2. Start at one end of your body—either your head or feet. Tense your muscles for
5 seconds at a time and then relax them for at least 10–15 seconds. When you tense
your muscles, breathe in. Work your way through all the muscle groups of your body.
3. When you relax your muscles, breathe out. As you breathe out, imagine all the tension
flowing out of your body with your breath.
4. Think about the muscles that you’ve relaxed. Let them become soft, loose and warm.

Techniques to help during labour
Cleansing breath
You Support person
■■ Take a slow, relaxed deep breath in at the ■■ When the contraction starts, stop any outside
beginning of your contraction. interruptions, such as other people asking
■■ When you breathe out, release all your questions. Say, “She’s just starting a contraction.
tension. We will answer you as soon as it’s done.”
■■ Focus all of your attention on her.
■■ You may want to time contractions so you
can tell her when she’s halfway through.
Focal point
You Support person
■■ Concentrate on something in the room or in ■■ You may be the focal point!

your mind. ■■ Remind her to focus or concentrate on
something.
Patterned breathing
You Support person
■■ Start with slow, deep and regular breathing. ■■ Watch carefully for tension and regular
■■ Breathe this way through the whole breathing.
contraction. ■■ If you see tension, ask her to relax these
■■ Some women find breathing in through the muscles, massage them or place your hands
nose and out through the mouth helps—find on tense areas. Say “Let your shoulders drop,” or
what works best for you. “Relax your arms—let them rest on my hands.”
■■ Many women use this type of breathing for
■■ You may notice that as the contractions
their entire labour. become stronger, her breathing becomes
faster. You can still say “Slow it down. Nice
and easy. Keep breathing. That’s right. Exhale,
breathe out.”
Cleansing breath
You Support person
■■ When the contraction is over, take another ■■ Remind her to take a cleansing breath.
big, deep breath in and out.
■■ Blow away the contraction completely.

Let go
You Support person
■■ Take a sip of water, and let that contraction go. ■■ Offer her a drink or ice chips. Look at her to
■■ Release any muscle tension. see if you can see any tension and remind
her to release it. Watch for signs from her on
■■ Listen to your body. You may want to walk and whether it’s time to walk or time to rest.
be active until the next contraction comes, or
you may need to rest.
■■ Some women use up a lot of energy
wondering about labour, like when the next
contraction will come, or how much longer
labour will last. It may help to remind her to
focus only on what’s going on right now.
When you’re the labour support person

Helping support a pregnant woman during labour takes time, energy and a lot of caring.
Be aware that you’re having your own emotions and experiences. Some women and their
partners may want to have a second support person who can support both of them. This
gives the partner a chance to take a break without having to leave the mom alone.
■■ Take care of your needs: someone who feels faint or is cranky because they haven’t
eaten can’t give good support. Take short breaks and remember to eat and drink to keep
yourself energized.
■■ Do not take anything personally: labour is hard, both emotionally and physically. It’s
common for women in labour to have stronger emotions—they may not act the way
they usually do.
■■ Make the environment comfortable: adjust the lighting and check the temperature.
Cut down on outside noise by closing the door or putting on some music. Keep the
curtain and door closed for privacy.
■■ Match her mood: if she’s talkative, talking is a great way to support her. If she’s quiet
and focused, you can offer a few words of encouragement. Do not start or continue
conversations when she’s focusing on her contractions. This will break her focus and
increase her tension. Ask her if there is anything else that would help her to be more
relaxed and stay more focused, like less noise or distractions.
■■ Remind her to listen to and trust her body: encourage her to choose positions,
movements and sounds that help her cope. If she is making high pitched sounds, this
can make her muscles tense up, suggest making low deep sounds.
■■ Ask her if she is managing the pain: if she is not, suggest another position or
comfort strategy.

■■ Help her keep her focus and confidence: at different times during labour, she may tell
you “I can’t do this” or “I’m tired of this.” In many cases, she’s just releasing her frustrations,
especially if she’s saying these things during a contraction. Talk with her once the
contraction is over and provide encouragement. Tell her how proud you are of her.
■■ Accept that her behaviour in labour may be different: she may make different
sounds and movements—that’s normal. She’s doing what she needs to do to bring the
baby into the world.
■■ Ask the health care providers questions: Make sure you understand what’s happen-
ing and ask for support when you need it.
■■ Help her to relax: Help her to release muscle tension or regain a rhythmic breathing
pattern. Be specific—say things like “Let go of tension right here” or “Breathe in with me”.
Breathing too fast

It’s possible for a woman in labour to breathe too fast (hyperventilate). If this happens,
she may:
■■ feel lightheaded or dizzy
■■ have tingling or numbness in her hands and feet
■■ have muscle spasms or cramps
If she feels any of these symptoms, try to get her to slow her breathing during
contractions. It may help to cup her hands over her nose and mouth or to breathe into a
paper bag.

Here are some tips to help support your partner to stay calm and focused.

How to tell if she is How to help her stay
calm and focused calm and focused
Watch her breathing: Say something like:
■■ Are her breaths slow and even? ■■ “Slow, deep breaths.”

■■ “Slow it down, nice and easy, in and out.”
■■ “Relax as you breathe out, focus on the out
breath, and let it out.”
Look at the muscles in her face: Say something like:
■■ Is her jaw clenched? ■■ “Let your jaw relax, with your teeth and lips
■■ Are her eyelids squeezed tight? slightly apart.”
■■ “Let your eyelids feel heavy, the muscles in your
face are soft and loose.”
Look at her body, especially shoulders,

Say something like:
arms, hands, legs and feet:
■■ Are her fingers clenched? ■■ “Let your (arm, foot, etc.) relax. Your muscles
■■ Are her shoulders pulled up to her ears? should feel heavy, soft, loose, and warm.”
■■ Are her legs and feet pulled up?
■■ “Your (arm, foot, etc.) feels like it’s sinking into
the chair. As you breathe out, let your muscles
become even softer, looser and heavier.”
■■ “Your (arm, foot, etc.) feels warm, comfortable
and relaxed. Lower your shoulders, unclench
your hands and relax your fingers.”

Second Stage of Labour: Birth
The second stage of labour begins when your cervix has thinned and is fully dilated to 10
cm. During the second stage, many women get a burst of energy to help them with the
work of pushing. Women often feel
encouraged knowing that they’ll
soon meet their baby.
The activity of the uterus changes in

the second stage of labour. During
the first stage, the uterus pulled up
on the cervix to thin and open it. In
the second stage, the uterus acts as a
pump to push down on your baby.
As your baby is pushed out of your uterus and into your vagina, your baby’s head presses
on your rectum. For many women, this rectal pressure feels as though they need to have
a bowel movement. You may find that when you baby is low enough in your vagina this
may happen and you can’t control your body’s urge to push. Some of the physical changes
of transition such as shaking, sweating and nausea, continue into the second stage of
labour. This is because your body’s still working very hard.
Pushing
Will I have a bowel movement
While the second stage begins with a fully
during pushing?
dilated cervix, pushing often doesn’t begin
It’s normal to pass a small amount of
right away. Many women get a natural
stool while pushing. Your health care
break of about 20–30 minutes before active
provider will wipe it away.
pushing begins.
You may feel a strong and uncontrollable urge to push, while others do not feel any urge
to push at all. However, most women will feel more pressure in their rectum. This will guide
you when and where to push.
Your health care providers will be more focused on you and your baby. They will help you
push effectively and help you find what works best for you.
Often you’ll be encouraged to push whenever you feel the urge to. It’s common to make
low, grunting sounds during pushing. Follow your instincts.

Birth

Just before your baby is born, there’s a
moment when the largest part of your
baby’s head is at the opening of your
vagina (crowning). This may feel like an
intense or strong burning sensation.
At this point, you’ll be asked to push

gently or pant, to ease your baby’s head
out slowly and prevent or minimize
tearing. Your health care providers will
guide you through this stage. After your
baby’s head is out, they will turn a bit,
the shoulders are then delivered, which
may need a small push from you, and
then the rest of your baby enters the
world! On rare occasions the baby’s top
shoulder may get stuck—your health
care provider will need you to listen
carefully to them so that they can help
you birth your baby safely.
Right after birth, your baby can be put

on your chest or abdomen for skin-to-
skin cuddling and to start breastfeeding.
Finally, the umbilical cord will be cut.
This is something many
partners like to do. It doesn’t
hurt your baby to cut the
cord. For more information
about skin-to-skin cuddling,
see page 209.

Third Stage of Labour: Separation
and Delivery of the Placenta
After your baby is born, as you relax and
cuddle together, there’s still one more
stage of labour to go through. The third
stage is the delivery of your placenta.
Your uterus will contract again, which
helps the placenta separate from the wall
of the uterus. This is much easier than
pushing out your baby. Many moms are
so involved with their new baby that they
are not even aware that the placenta has
been delivered. You can ask to see it if you
want—this is what kept your baby alive all
of these months!
The placenta usually separates within Placentophagy

10–30 minutes after your baby is born. There are no proven benefits to
You may or may not feel a mild cramping. placentophagy, however there are
risks. Placentophagy can increase the
You may be given an injection of synthetic
risk of infections in both you and your
(human-made) oxytocin to help prevent
baby and may also increase your risk of
too much bleeding and to help your uterus blood clots.
start to get smaller and return back to its
pre-pregnancy size.
“ After waiting for nine months to see my baby, planning the nursery, taking my
maternity leave, I couldn’t believe it when I actually went into labour. It all felt
”
like such a whirlwind. And at the end of it, they handed me my baby. How did it
happen? Here I was, a mom.
~ Adeela, mom of a baby
placentophagy: consumption of the placenta in either a raw, cooked or encapsulated form

Pain Relief Options During Labour

Along with staying calm and focused, working with your body during labour, and using
different positions, there are other ways to relieve pain during labour. Your health care
provider and childbirth educator can help you learn what other choices you have to help
manage labour pain. It’s a good idea to know more about these options before your
labour begins.
Narcotics
Pain medicine such as morphine and fentanyl are narcotics. They’re given by injection into a
muscle (IM) or into a vein (IV).
Benefits Things to think about
■■ Makes the labour pains feel like they are not ■■ May cause you to feel dizzy, nauseated or
as strong. drowsy.
■■ Can be used throughout labour. ■■ May make your baby drowsy which can affect
■■ Some birth centres have pumps so you can your baby’s breathing and breastfeeding.
control when you want the medicine. Your health care providers will take care of
your baby if this happens and help you to
breastfeed.
Transcutaneous Electrical Nerve Stimulation (TENS)

TENS is given through electrodes that are placed on your skin. A mild electric current mixes up
the pain messages to your brain so you feel less pain.
■■ May relieve pain in ■■ Works most effectively if you start using TENS
early labour. in early labour, otherwise it won’t work as well
■■ You control how in active labour. It works best if you replace
strong the current is. the batteries every 4–6 hours.
■■ Helps take your
■■ Can’t be used in the bath or shower.
mind off the pain. ■■ You’ll have to rent or buy a TENS machine and
take it with you—most birth centres do not
have them.
Photo reproduced with permission from Greer, H. (2017).

Entonox®
Entonox® is also known as ‘laughing gas’ or ‘gas and air’. It’s a mixture of 50% nitrous oxide and
50% oxygen. You get the gas by breathing through a face mask or a mouthpiece when you
have a contraction.
■■ Gives some pain relief at any stage in labour. ■■ May cause

■■ You control how much you get. dizziness, nausea,
numbness or
■■ Takes your mind off the pain and helps you tingling.
relax.
■■ Doesn’t stop the
■■ Doesn’t have long-lasting effects on you or pain.
your baby.
Epidural
An epidural (anesthetic) can be given during labour.
The epidural blocks the pain in the lower part of
your body. The doctor who gives the epidural
(anesthesiologist) numbs the skin in your lower back.
Once the skin is numb, a needle is inserted between
the bones of your spine into a space between the
layers of membranes in your spinal column. A thin
plastic catheter is threaded through the needle. The
needle is then taken out and the catheter is taped
in place. A pump delivers the medicine to keep you
comfortable throughout your labour.
With an epidural, your blood pressure, your heart rate
and your baby’s heart rate will be checked often.
Before an epidural, you’ll be given information about
the procedure and give consent either verbally or
in writing. Your anesthesiologist can answer your Reproduced with permission from
© www.pattiramos.com
questions.
Most women who want an epidural can have one, but there are some medical conditions
that can prevent a woman from having an epidural. There may also be times when one is
recommended. If you’re interested in having an epidural in labour for pain control, talk with your
health care provider ahead of time.


Epidural
■■ Can give the best pain relief. ■■ It may slow or stop labour if given before you’re in
■■ Can be used throughout labour. active labour. If contractions slow down, you may be
given synthetic oxytocin to stimulate labour.
■■ Easy to give more medicine when
needed.
■■ You must have an IV started before you’re given the
epidural as it may lower your blood pressure, which
■■ Pain relief is quick, and begins within could slow your baby’s heart rate for a short time.
5–10 minutes, then usually fully
effective by 20 minutes.
■■ You may have trouble passing urine and may need a
catheter in your bladder during labour to drain your
■■ Can let you rest so that you have urine.
strength to push.
■■ You may not feel the urge to push and need forceps
■■ Some women are able to push better or a vacuum to assist with the birth.
with an epidural since their pain has
been relieved, but they can still feel the
■■ You may have to stay in bed because your legs may
pressure. The amount of medicine can feel weak. You may be able to get up to go to the
also be adjusted so that you can feel bathroom with the help of your health care provider.
enough to know when to push. ■■ You may shiver or feel itchy.
■■ Can give pain relief during back ■■ You may develop a mild fever during labour. Your
labour and during interventions such health care provider will monitor this if it happens.
as vacuum or forceps for an assisted ■■ You may have a headache after the epidural wears
birth. off. This can be treated.
■■ Can be used when other pain methods ■■ You may feel bruised at the site of the epidural. This
to manage pain haven’t worked. usually goes away within a week.
■■ If you need a caesarean birth you may ■■ There is a very, very small chance that you can have
be able to be awake. breathing problems, infection, nerve damage or
paralysis.
Pushing with an epidural
■■ Once your baby is low enough, most women who’ve had epidurals can still feel some rectal
pressure—this will help you to know when to push.
■■ woman with an epidural can also put her hands on her abdomen and feel her uterus tighten
A
up—this will also signal you to push.
■■ I f you do not have an urge to push, many health care providers will give you more time before
starting active pushing. This will help you keep up your energy as pushing without an urge to do
so can be very tiring.
■■ The amount of medicine can also be adjusted by your health care providers so that you can feel
enough of the contraction to know when to push.
■■ Your health care providers will also let you know when your contractions are happening and tell
you when to push.
vacuum: a small cup, connected to a suction pump that your health care provider uses to guide your baby out of the
birth canal
forceps: metal, spoon-like instruments health care providers use to gently guide your baby out of the birth canal

Other Procedures During
Labour and Birth
During labour and birth, your health care provider may suggest one or more medical
procedures to help you or your baby. They will talk with you about the benefits and risks.
Knowing about these procedures ahead of time will help you be prepared if you need any
of them.
Fetal monitoring
A fetal monitor is a machine that keeps track of your contractions and your baby’s heart
rate during labour. Labour can be stressful for your baby—their heart rate may get faster
or slower. It’s serious when a baby’s heart rate is too fast or too slow. By checking how
your contractions affect your baby’s heart rate, your health care provider can monitor how
your baby is doing. There are two ways to monitor your baby’s heart rate during labour—
intermittent or continuous monitoring.
Intermittent monitoring
This method means that your baby’s heart rate is being checked when needed. Health
care providers will likely listen to your baby’s heart rate every 15–30 minutes during the first
stage of your labour and every 5 minutes while you’re pushing.
If your pregnancy is low risk and your labour is going well, this method works as well as
listening to your baby’s heart rate continuously.
Continuous monitoring
This method means that your baby’s heart rate is always being checked. The monitor
measures both your contractions and your baby’s heart rate. Continuous monitoring is
used in active labour when intermittent checking is not enough, such as with synthetic
oxytocin infusions or after a previous caesarean birth. There are two types of continuous
monitoring, external and internal. External monitoring is the most common.
External monitoring
Two sensors are placed on your abdomen and held lightly in place by elastic belts. One
sensor measures your baby’s heart rate through ultrasound. The other sensor measures
and times each contraction by picking up the pressure of your uterus as it tightens.

External monitoring doesn’t measure

how strong the contractions are, just how
often they’re happening. Although fetal
monitoring doesn’t cause discomfort,
sometimes you may not be able to move
around very much while it’s being done.
Check with your health care provider to see
if you can move around or if you can stand
next to the bed or sit on a birth ball.
Internal monitoring
When your baby needs closer monitoring,
a thin wire (electrode) is guided through
your vagina and cervix and placed on your
baby’s scalp. It will feel the same as having
a vaginal exam done. The electrode is
plugged into a machine.
The electrode doesn’t hurt your baby,

although it will leave a small scratch on
their scalp for a few weeks. Monitoring
by this method is more accurate, as it picks up the electrical impulse of your baby’s heart.
Check with your health care provider to see if you can stand beside the bed or take short
breaks to use the bathroom to empty your bladder while the monitor is in place.
Inducing labour
While many women go into labour on their own, sometimes labour needs to be
stimulated (induced). To get your labour started your health care provider may sweep
(strip) the membranes during a vaginal exam. This is done by inserting a gloved finger into
your cervix and separating the membranes from the lower part of your uterus at the edge
of the cervix. There may be some discomfort during the procedure or light spotting after.
Normally, your cervix begins to ‘ripen’ near the end of pregnancy. If it doesn’t, your health
care provider may help it get ready for labour by inserting either:
■■ prostaglandin gel into your vagina close to your cervix
■■ a slow-release packet of prostaglandin gel close to your cervix
■■ a catheter with a balloon on one end into your cervix
scalp: the skin covering the head, not the face

If an induction has been suggested, your health care provider will talk with you about the
benefits and risks.
There are 3 ways to induce labour:

■■ Breaking the amniotic sac (manually rupturing the membranes): this procedure is
done during a vaginal examination. It can be done before or during labour. It releases
some of the amniotic fluid that surrounds your baby. It may also help to stimulate
contractions by letting your baby’s head press on your cervix. This pressure causes pros-
taglandins to be released, which ripen or soften the cervix and stimulate contractions.
■■ Using prostaglandin: this can be a gel or in the form of a tampon that can be inserted
into the vagina to stimulate contractions.
■■ Giving synthetic oxytocin: this is given through an IV. The IV rate is increased until
you’re having regular contractions that start your labour. Everyone responds differently
to this medicine and in rare cases, it may not always start labour.
Reasons for inducing labour Things to know
■■ You’re more than one week past your ■■ It may increase the need for an epidural,
expected due date. vacuum or forceps assisted birth, or a
■■ The placenta is not supplying the proper caesarean birth.
amount of nutrients and oxygen to your ■■ It may stimulate the uterus too much—
baby. contractions that are too close together may
■■ Your baby is not moving as much as usual. stress your baby.
■■ Your baby is not growing as expected or has
■■ It may not start labour.
a health problem. ■■ It may increase the risk of infection and other
■■ You have high blood pressure or diabetes. interventions.
■■ You have a normal twin pregnancy that is
37–38 weeks or more.
■■ Your amniotic sac has broken, you’re at your
due date and your contractions haven’t
begun after 12–24 hours.
■■ Your amniotic sac has broken and your Group
B Strep swab is positive. Antibiotics will also
be started.

Augmentation

If active labour has started, but the contractions slow or stop, your health care provider
may suggest stimulating contractions (augmentation). This can help the contractions
come more often and become stronger. Augmentation can be done by manually
rupturing the membranes and by giving synthetic oxytocin through an IV.
Episiotomy
To make the vaginal opening bigger, a cut is sometimes made through the perineum
(episiotomy). An episiotomy is not a routine procedure. It may be recommended by your
health care provider if they feel that more room is needed for your baby or your baby
needs to be born quickly.
Things you can do that may help prevent an episiotomy:

■■ Do perineal massage during your third trimester (see page 152).
■■ Use warm compresses on your perineum.
■■ When pushing, use positions such as sitting upright, lying on your side or kneeling on
all fours.
■■ Control your pushing, when and how hard you push, during your baby’s birth. Your
health care providers will guide you with the pushing.
Reasons for an episiotomy Things to know
■■ To speed up the birth if your baby is having ■■ It may increase the risk of infection.
trouble. ■■ It can be uncomfortable and painful.
■■ To make more room if it your health care ■■ It could lead to a tear.
provider thinks that a tear will be bigger if no
episiotomy is done. ■■ It usually heals in about 4 to 6 weeks.
■■ It may cause painful sexual intercourse the
first couple of times after it heals.
If you’ve had an episiotomy or a tear, your health care provider will stitch it up. A local
anesthetic (freezing) is injected in the area, unless you’ve had an epidural. The anesthetic
will decrease the pain during the stitching. These stitches do not need to be taken out—
they’ll dissolve with time as your perineum heals.

Forceps
Forceps are metal, spoon-like instruments. Between your contractions, your health care
provider may use forceps to gently cradle the sides of your baby’s head. When you push,
they will gently pull to help guide your baby out through the birth canal.
Reasons for the use of forceps Things to know
■■ To speed up the birth if your baby is having ■■ Can cause tears to the vagina, rectum or
trouble. perineum.
■■ To help with the birth if you’re not able to ■■ There may be some bruising or swelling on
push or if you’re too tired to push. your baby’s head or face.
■■ To help adjust the position of your baby’s ■■ In very rare cases, it can cause bleeding inside
head if it’s not in the right position. the baby’s skull.
■■ To protect the head of a premature baby
during birth.
■■ To avoid a caesarean birth when a vaginal
birth can still be done safely.
■■ To help deliver your baby’s head during a
vaginal breech birth.
Vacuum assisted birth

A vacuum used for an assisted birth is a small, soft, plastic cup connected to a suction
pump. The cup is inserted through your vagina and is placed on your baby’s head. Your
health care provider uses a controlled amount of suction to help guide your baby out
through the birth canal while you push.
Reasons for a vacuum assisted birth Things to know
■■ To speed up the birth if your baby is having ■■ Can cause tears to the vagina, rectum or
trouble. perineum.
■■ To help with the birth if you’re not able to ■■ There may be some bruising or swelling on
push or if you’re too tired to push. your baby’s head or face.
■■ To avoid a caesarean birth when a vaginal ■■ In very rare cases, it can cause bleeding inside
birth still can be done safely. the baby’s skull.
breech: when your baby is buttocks (bottom) or feet first in your uterus

Caesarean birth

A caesarean birth (c-section) is when your baby is born with the help of a cut (incision)
made into your abdomen and uterus. Some caesarean births are planned and others are
unplanned and done in an emergency. If a caesarean birth is suggested, your health care
provider will talk with you about the benefits and risks and how you can prepare. If you
have a caesarean, you‘ll be in an operating room for the birth of your baby.
Planned caesarean
Sometimes a vaginal birth is not possible or would be a risk to you or your baby. Some
reasons a caesarean birth may be needed are:
■■ if you’ve already had a caesarean birth and your health care provider does not
recommend a vaginal birth after a caesarean (VBAC)
■■ when your baby is in any position that is not safe for a vaginal birth, such as a breech
or a transverse lie
■■ if you have an active herpes virus infection, to prevent the virus from spreading to your
baby as your baby moves down the birth canal
■■ if you’re expecting more than one baby and there are problems with the position of the
your babies
■■ if your placenta lies partly or entirely over part of or over your cervix (placenta previa)
Breech presentation Transverse lie
transverse lie: when the baby is in a sideways position

Unplanned caesareans
An unplanned caesarean birth may be needed when:
■■ Your baby is too large to safely fit through ■■ Your placenta begins to separate from the
your pelvis. wall of the uterus before birth (placental
■■ The position of your baby’s head causes abruption).
the labour to not progress as expected. ■■ The amniotic sac breaks suddenly. The
■■ Changes in your baby’s heart rate show umbilical cord can be carried along and
they are not tolerating the stress of become caught between your baby and
labour. your pelvis (cord prolapse). This can affect
the amount of oxygen your baby gets.
■■ Your blood pressure is too high to tolerate
labour.
■■ Your baby has a certain birth defect or
other health issue, and may not be able to
■■ You have an infection in your uterus. tolerate labour and birth.
What will happen in the operating room

What happens during a caesarean birth is the same whether it’s planned or unplanned.
You’ll be given either a regional anesthetic (spinal or epidural) or a general anesthetic.
With a regional anesthetic, you’ll only feel light touches below your breast line. You’ll be
awake and alert during the surgery when you have a regional anesthetic.
With a general anesthetic, you’ll stay asleep during the birth of your baby. The general
anesthetic is usually used when your baby has to be delivered very quickly because of a
life-threatening problem with you or your baby. You may be able to talk with your health
care provider about the kind of anesthetic you prefer. There may not be time to talk about
all of these details in an emergency.
regional anesthetic: medicine given through a needle inserted into a space surrounding your spinal cord. Allows you
to be awake and alert during your surgery.
general anesthetic: medicine that puts you completely to sleep during the birth of your baby

Here are some things to expect during a caesarean birth:

■■ You’ll lie on an operating room table that ■■ There will be many health care providers
tilts slightly to the left. There are supports in the room to care for you and your
on the side to keep you from slipping. baby.
■■ Your blood pressure and heart rate will be ■■ Once the anesthetic is working, the
monitored. surgery will begin.
■■ Your abdomen and thighs will be washed ■■ If you have a regional anesthetic you
and covered with a sterilized cloth or won’t feel any pain but you may feel
drape, leaving only a small area on your pressure.
abdomen showing. ■■ Your baby will be delivered through a
■■ Your arm(s) with the IV will rest on an arm small incision on your abdomen.
board, away from your body. ■■ A screen will be put up so you do not see
■■ Your support person may or may not be the surgery. It may be lowered so you can
able to stay in the operating room. see the birth.
■■ A catheter will be inserted into your
bladder.
Your support person

Your support person may be able to come with you into the operating room if you have
a regional anesthetic, they’ll also be able to talk with you during the caesarean birth. They
can help you to relax and get comfortable. This may not be possible if you’re having a
general anesthetic, or if there’s an emergency.
After a caesarean birth

■■ Ask to have your baby placed skin-to- ■■ You’ll have some pain in your abdomen.
skin with you or your support person Talk with your health care provider about
right after birth so you can bond with pain medicine to help you feel more
your baby. comfortable.
■■ You’ll likely start on a liquid diet and then ■■ You may still have a catheter in place for a
move to solid food as soon as you’re able. few hours.
■■ The IV will come out once you’re ■■ If you have staples, or stitches that do not
eating well. dissolve on their own, your health care
provider will make arrangements to have
them taken out.

For breastfeeding, your health
care provider will help you cuddle
skin-to-skin and find a comfortable
breastfeeding position.
You’re not only recovering

from the birth of your baby,
but also from surgery. Taking
care of yourself will help you
recover faster. Eat healthy foods
throughout the day, drink plenty
of fluids and get enough rest to
help you recover.
You may have many feelings depending on your expectations and the reason for your
caesarean birth—happy, relieved, sad or disappointed. If the caesarean birth is an
emergency, you may have had little time to get ready for it. If you have any questions or
concerns, talk to your health care provider, partner or someone you trust.
Many women can have a vaginal birth after a caesarean birth in later pregnancies. Talk with
your health care provider about this before or during your next pregnancy.
“ ”
I had a caesarean birth. Birth is ‘natural’ no matter where it happens or how—
it’s about what is best for you, your baby and your family.
~ Jenika, mom of a toddler

Postpartum:
The First 6 Weeks

205
Postpartum: The First 6 Weeks
Congratulations, your baby is here! The first 6 weeks after your baby’s birth
is called the postpartum period. During this time, you’ll be recovering from
labour and birth and getting to know each other as a family. This chapter
has information about the physical and emotional changes you may go
through after having your baby. It also has information about taking care
of yourselves and your first few days with your new baby. Information on
caring for your baby can be found in the book Healthy Parents, Healthy
Children: The Early Years or visit healthyparentshealthychildren.ca
206
Congratulations Your Baby is Here!
P O S T PA R T U M : T H E FI R S T 6 W E E K S
Name:
Birthday:
Time of birth:
About my baby
Weight:
Length:
Head Size:
Birth Centre:
Health care providers who helped at my baby’s birth:
My labour support person(s):
Letter to my baby

At the Birth Centre
You’ll stay in the birth centre for around 12–36 hours after your baby is born. If you had a
caesarean birth, your stay may be longer. The health care providers at your birth centre will
help you care for yourself and your baby. They will encourage you to cuddle skin-to-skin
and will ask you how you want to feed them. If you’re breastfeeding, you’ll be encouraged
to breastfeed your baby within the first hour after birth, or as soon as you and your baby
are ready.
Your health care providers will check both you and your baby to ensure you’re
both healthy.
You will:
■■ be checked for your overall physical well-being
Questions or concerns?
and vaginal blood flow
If you have questions or
■■ have your uterus checked to make sure it’s firm concerns about how your
■■ have your blood pressure, breathing, pulse and baby’s doing, talk with your
temperature checked health care provider.
■■ have your vaginal area checked if you had a

vaginal birth
■■ have your incision checked if you had a caesarean birth
■■ be asked how your pain is and given medicine to treat the pain, if you need it
Your baby will be:

■■ weighed and measured
■■ checked for their overall health, which includes breathing, heart rate, skin colour, muscle
tone and reflexes when they’re 1 and 5 minutes old (Apgar score)
■■ given erythromycin antibiotic ointment in their eyes to help prevent an infection that
could lead to blindness
■■ given an injection of vitamin K in their thigh within 6 hours of birth to help prevent
bleeding which could lead to brain damage and even death
Your baby will stay in your room beside your bed in a small, portable crib or bassinet. Keep
your baby’s crib or bassinet close by at all times. This is a safe place for your baby to be
when you’re asleep. Always put your baby to sleep on their back. Being together in the
same room will help you and your baby get to know each other.

Getting to know your newborn skin-to-skin
Your health care providers at the birth centre will encourage you and your partner to talk
and cuddle with your baby skin-to-skin for as long as you can. Skin-to-skin cuddling will
help you to bond with your baby and it also provides other great benefits, like promoting
early and frequent feeding.
Cuddling your baby skin-to-skin is a good way to ease them into the outside world.
■■ Hold your baby chest-to-chest with your baby
wearing only a diaper. With their head on your
bare chest, your baby can hear your heartbeat
and smell you.
■■ Cover your baby’s back with a blanket for
warmth. Do not cover your baby’s head with a
blanket as this may make breathing difficult.
■■ Stay awake when cuddling with your baby to
prevent them from falling.
Cuddle your baby skin-to-skin before and after

feedings, and as often as you want, for the next
few weeks. You can also ask that baby exams be
done while holding them skin-to-skin, if possible.
Photo courtesy of the United States
Skin-to-skin cuddling is a way for your baby to Breastfeeding Committee
use all five senses to get to know you and your

partner. It also helps:
■■ regulate your baby’s heart rate, breathing and
blood sugar
■■ keep your baby warm if they’re too cool—
your body temperature can raise theirs by
2 °C (3.6 °F)
■■ cool your baby if they’re too warm—your body
temperature can lower theirs by 1 °C (1.8 °F)
■■ your baby gain weight
■■ your baby be calm and cry less

■■ For moms, skin-to-skin cuddling, can:
Stay awake while cuddling
increase hormones that make breastmilk
and help milk flow It’s important to stay awake when
cuddling your baby. If you’re feeling
promote breastfeeding and help your tired or drowsy, put your baby on
baby latch more easily to your breast their back in their own crib, cradle or
■■ For both moms and dads, skin-to-skin bassinet.
cuddling can:
help you feel relaxed and lower stress levels
Breastfeeding
It may take up to an hour or more for your baby to be
ready to feed. Ask your health care provider to help you
breastfeed your baby as soon as you’re comfortable. To
help get your milk supply established, breastfeed your
baby early and often. It’s easier to start breastfeeding
when you and your baby are doing skin-to-skin cuddling.
For more information about breastfeeding, see page 273.
Vitamin D for newborns

All newborn babies should be given a liquid vitamin D supplement of 400 IU every day.
Follow the directions on the bottle. If you have questions, call Health Link at 811 or your
How your newborn looks

You’ve been waiting a long time to meet your baby and you may notice some differences
in how your baby looks compared to other babies you’ve seen. That’s because newborns
look quite a bit different than babies who are a few weeks old.
Skin
■■ Slippery white coating (vernix): Your
baby’s skin may be covered with vernix that
protected their skin in your uterus. It will
be absorbed or washed off within the first
24–48 hours.

White spots (milia): Your baby may have
■■
milia around their nose that may last a few How big are full term
months. These white spots will go away on newborns?
their own—do not try to remove them. Most newborns weigh between
2500–4000 g (5 lbs 8 oz–8 lbs 13 oz).
■■ Fine, downy hair (lanugo): Your baby may
have lanugo on their forehead, ears and
shoulders. Lanugo usually disappears within 2 months.
■■ Dry or peeling skin: Your baby’s skin may be dry and peeling, especially on their hands
and feet. Talk with your health care provider about using any creams or lotion on your
baby’s skin if it’s still dry after a few days.
■■ Black or blue marks (congenital dermal melanocytosis): You may see these marks
on your baby’s body, usually on their back or bottom. They look like a bruise, but they
are not and they’ll usually fade in the first or second year of life.
■■ Reddish areas or stork bites (hemangiomas): You may see these areas on your baby’s
forehead, eyelids, nose or on the back of their neck. These marks usually fade and are
gone by the time your child is 3 years old.
Head and face

■■ Soft spots (fontanelles): the anterior
soft spot is found on the top of your Front of head
baby’s head and the posterior fontanelle
is at the back of their head. The bones
Anterior
of your baby’s skull haven’t joined yet, fontanelle
allowing their brain to continue to grow.
The soft spots will join together as your
baby gets older. Gently touching the
soft spots won’t harm your baby. The Posterior
fontanelle
soft spot near the front closes between
6–24 months. The soft spot near the
back of their head might be very small
and closes between 8–12 weeks. Back of head
■■ Head shape: few newborns have
perfectly shaped heads. It may take up to
6 weeks for your baby’s head to become round.
■■ Hair: your baby may have lots of hair or no hair at all. Babies may lose some of their hair
soon after birth. Their hair may also change colour.

■■ Eyes: your baby’s eyes may be swollen from the birthing process. Their eyes may be
sensitive to bright lights in the first few days. This is because your baby is used to being
in the dark. It’s common for their eyes to change colour during the first year. Some
babies may look cross-eyed until about 3 months of age. If this doesn’t go away as your
baby grows, talk with your health care provider.
■■ Nose: your baby’s nose may be flat or bruised. It will get to its normal shape and the
bruising will go away in time.
■■ Mouth: your baby’s mouth should be pink and moist.
Body
There are other normal changes you may notice with your baby. These temporary changes
are caused by your baby being exposed to your hormones before birth.
■■ Swollen breasts: your new baby (male or female) may have swollen breasts that
sometimes leak a milky discharge. This may last for a couple of weeks.
■■ Swollen genitals: your baby (male or female) may have swollen genitals for the first
few days.
■■ Vaginal discharge: your female baby may have white, pink or red discharge from their
vagina during the first week.
Umbilical cord
The umbilical cord joined you and your baby
before birth. When your baby is born, the cord Cord clamp
is clamped and cut, leaving a clamp and a If you want to have your baby’s cord
small amount of cord attached to your baby. clamp removed for cultural reasons,
Your baby’s umbilical cord will look bluish- talk with your health care provider.
white. As the cord dries, it’s colour changes to
a yellowish-brown then a greenish-black. A small amount of oozing or bleeding is normal
when the cord starts to fall off.
The cord and cord clamp usually fall off on their own after 1–3 weeks after birth. The cord
will harden and turn greenish-black as it dries. If the cord is still attached when your baby is
3 weeks old, talk with your health care provider.

How to care for your baby’s umbilical cord:
■■ Keep the area around their cord dry. This Call Health Link at 811 or
will help it stay clean. your health care provider if
the umbilical cord or the skin
Wash your hands before touching
!
■■
around the cord has any of
their cord.
the following:
■■ Keep their diaper folded below their cord ■■ a lot of blood
so that the cord remains dry.
■■ is red, warm or swollen
■■ You can give your baby a full bath before
the cord falls off. After the bath, fully dry
■■ a discharge that smells bad
the cord with a cotton-tipped applicator,
like a cotton swab or the tip of a clean
cloth, before dressing your baby.
■■ Clean any discharge from around the cord using a cotton-tipped applicator dipped in
tap water, then dry it well with dry cotton tipped applicators.
■■ Cleaning the cord with alcohol is not recommended.
■■ Do not put coins, buttons, bandages and binders on the umbilical cord.
When your baby cries

Starting from birth, all babies cry. Crying is a way your baby communicates with you and
tells you that they need your help. It may mean they’re hungry, need a diaper change,
want to be held, are tired, or do not feel well.
Your baby’s crying may increase at about 2 weeks and peak when they’re about 2 months
old and then gradually decrease. On average, babies cry about 2 hours total throughout
the day. Some babies cry more, some less. Babies can:
■■ sometimes cry for 30–40 minutes at a time
■■ cry more in the afternoon or evening
■■ sometimes look like they’re in pain when they cry
There will be times when you won’t know what your baby is trying to tell you. Try to make
your baby more comfortable during this time. As a new parent you’ll learn your baby’s
cues and that your baby cries differently for different reasons. Ask your partner for help
when you need it and do your best to stay calm.
cues: movements, sounds and facial expressions your baby uses to tell you what they need and what they’re feeling

You can try to soothe your baby by:
■■ making your baby as comfortable as ■■ feeding them slowly and burping
possible (not too hot or too cold) them often
■■ changing their wet or dirty diapers ■■ gently rocking or walking with them
■■ changing the position you’re holding ■■ talking, singing or playing soft, relaxing
them in music to them
■■ cuddling skin-to-skin
Sometimes babies can’t stop crying no matter what you do to try to soothe them. Being
unable to soothe your baby doesn’t mean you’re a bad parent. It also doesn’t mean your
baby is angry with you. It can take time to understand the reasons that your baby is crying.
If your baby can’t be soothed, call Health Link at 811 or your health care provider.
It’s more important to stay calm than to stop the

crying. If you’re feeling stressed, frustrated or angry: Take a break,
don’t shake
■■ put your baby in a safe place like their crib
It’s more important to stay
■■ leave the room and gently close the door calm than to stop the crying.
■■ take time to calm yourself before you try again
Letting your baby cry for a few minutes won’t hurt them. Holding your baby when you’re
frustrated or angry could lead to shaking. Never shake your baby for any reason. Shaking
may cause a baby to be blind, unable to walk, and to have learning problems. In some
cases shaking can even cause death.
Talk to your health care provider and make a plan for how you’ll cope if their crying gets
to be too much. It’s okay to ask for help. Have the phone numbers of people that can help
when the crying is too much, such as:
■■ your partner, neighbour, relative or friend who can come over right away and help
■■ your doctor or your public health nurse
■■ Health Link at 811
Information on crying and creating a crying plan can be found in the book Healthy Parents,
Healthy Children: The Early Years or visit healthyparentshealthychildren.ca

Safe sleep
Babies spend a lot of time sleeping and
need a safe sleep environment. Some
sleep environments can put babies at risk
for sleep-related death such as SIDS. You
can reduce the risk of SIDS and prevent
other sleep-related injuries and deaths in
babies. Here’s what you can do to help
protect your baby in their first year:
■■ Put your baby on their back to sleep,
every sleep.
■■ Use a crib, cradle or bassinet that meets Cribs with drop-sides
Canadian safety standards. As of December 2016, traditional drop-
■■ Keep the crib, cradle or bassinet free of side cribs cannot be advertised, sold,
clutter, like stuffed toys, bumper pads or imported or manufactured in Canada.
If you have a drop-side crib, consider
pillows.
replacing it. If you continue to use
■■ Keep your baby warm, not hot. it, make sure it hasn’t been recalled
and meets current Canadian safety
■■ Keep spaces smoke-free before and after
regulations. Ensure that both sides are
your baby’s birth (see page 71).
in the up and locked position when
■■ Share a room with your baby for the first your baby is in the crib and stop using it
6 months, but do not share a bed or if it has any loose or missing parts.
sleep together anywhere else.
■■ Breastfeed your baby.
Soothers (pacifiers) are often used to help babies calm and self-soothe. Research tells us
that using a soother may help reduce the risk of SIDS. However, the research is not clear
if soothers will interfere with breastfeeding or not. Soothers can be used if your baby is
growing well and you use it once you know
Bed sharing is not safe your baby is fed and no longer hungry. If you
Sharing a bed, sofa or any other
use a soother, and your baby falls asleep and it
sleep surface with your baby is falls out, there’s no need to place it back in their
not recommended. This has been mouth.
a factor in a number of deaths
related to SIDS. Information on safe sleep can be found in the
book Healthy Parents, Healthy Children: The Early
Years or visit healthyparentshealthychildren.ca

Preventing falls
Here are some tips to help prevent you and your baby from falling:
■■ Have someone help you the first time you get out of bed after your baby is born—do
not get up alone.
■■ Use your call bell to get help if you feel dizzy or faint.
■■ Put your baby in the portable crib, cradle or bassinet—do not carry them in your arms if
you go outside your birth centre room.
■■ Stay awake while feeding or holding your baby—try chewing sugar-free gum, wiping
your face and neck with a wet cloth or keeping the room lights, TV or music on.
■■ If you feel sleepy, put your baby in their crib, cradle or bassinet.
■■ Always stay with your baby when they’re on a high surface like a bed or change table.
Keep one hand on them at all times. Newborn babies kick and wiggle and can move
enough to fall. This can happen very fast.
Keeping your baby safe at the birth centre

You and your baby will be given matching identification bands before you leave the
birthing room. Your arm band will be checked with your baby’s ankle bands every time
you and your baby have been apart to make sure they match. Both identification bands
need to stay on while you’re at the birth centre.
Most birth centres will have limits about who can visit labour and delivery as well as
postpartum units. While infant abduction is very rare, there is a risk.
Here are some steps you can take to

help keep your baby safe:
■■ Make sure you’re shown birth centre
identification before handing your
baby to someone who says they are a
staff member.
■■ If you’re not comfortable with
someone taking your baby, say “No”
and call a health care provider.
■■ Never leave your baby alone in your
birth centre room.

Newborn blood spot screen
When your baby is 24–72 hours old, you’ll be offered blood spot screening for your baby. A
few drops of blood are collected from a heel poke to test for treatable conditions like:
■■ problems with how the body uses food to grow and develop (metabolic conditions)
■■ problems with how the body makes hormones (endocrine conditions)
■■ cystic fibrosis, a condition that affects the lungs and digestive system
The screening is quick, safe and the best

way to tell if your baby has a treatable
condition that you or your health care
provider might not know about. Treating
these conditions early can prevent health
problems, improve your baby’s health
and maybe even save your baby’s life.
If your baby is over 24 hours old before
you’re discharged, the screen will ideally
be done at the birth centre before your
baby goes home. It may also be done at a
home visit, a clinic visit or a lab in your community.
To learn more about newborn bloodspot screen, visit the Links section at
Newborn hearing screening

You will be offered to have your baby screened for permanent hearing loss by the time
your baby is 1 month old. As your baby grows, permanent hearing loss can affect speech,
language and learning skills. Have your baby’s hearing checked early, so that support and
care can be given if needed.
Screening can be done while your baby is quiet or sleeping and will not hurt them. For the
screening test, sounds will be played into your baby’s ears and a computer will measure
how well your baby hears the sounds.
To learn more about newborn hearing screening, visit the Links section at

When a baby needs special care
Sometimes newborns need more special care. They may need to be moved to a special
care nursery or neonatal intensive care unit (NICU), at your birth centre or another hospital.
If your baby is admitted for special

care, you’ll be able to visit them
often and stay for as long as you
want. The health care providers
will help you understand how your
baby is doing and how you’re an
important part of your baby’s care.
They’ll give you as much

information and support as possible.
Ask your health care providers
at your birth centre about any
guidelines for other visitors. Feel
free to talk about your feelings and
ask questions.
If your baby needs special care, here are some things that may help you and your baby:
■■ If your baby is moved to special care right ■■ Ask your health care providers to explain
after birth, your support person can go what’s happening with your baby.
with them. ■■ Ask your health care providers to help
■■ After the birth, your support person may you do skin-to-skin cuddling with your
be almost as tired as you are. If you have baby when they’re ready.
a back-up support person, ask them to ■■ If you’re planning to breastfeed, your
come to the birth centre. Your backup health care provider will show you how
support person can help while you and to express or pump your milk. They will
your main support person get some rest. encourage you to provide breastmilk
■■ Be with your baby as soon as possible. for your baby until they are able to
Your baby will hear and smell you. Being breastfeed. Pumping your breasts early
there will comfort them, even if you can’t and frequently will help you to establish
hold them yet. and maintain your milk supply until your
baby is ready to breastfeed.
After you and your baby leave the birth centre, your health care provider will continue to
support you and your family.

“
Our baby boy was born very early. We were uncertain about the impact for
him because he needed to be in the incubator, and we couldn’t be there all the
time. Within the first few days, nurses encouraged us to begin skin-to-skin with
either parent. I feel this made a world of difference to our baby and to us in
”
helping with healthy growth and attachment…even in our connection now—
years later.
~ Rob, dad of a preschooler
Registration of birth
All babies born in Alberta must have their birth registered. After your baby’s birth, you’ll
be given forms to complete at the birth centre. You must fill in the Government of Alberta
Registration of Birth form and leave it at the birth centre. This form is the legal record of
your baby’s birth and includes:
■■ where your baby was born
■■ your baby’s name
Home birth package
■■ names of parents
If you gave birth at home, you
The Government of Alberta may need to request a package
Registration of Birth form is used to of forms to register your baby’s
birth. Contact the Vital Statistics
apply for a Social Insurance Number
Office. In Edmonton, call toll-free at
and Canada Child Benefit. There is no
780-427-7013. Elsewhere in Alberta, call toll-
cost to register for these. In order to free at 310-000, then dial 780-427-7013. For
receive this benefit, you’ll need to file more information, visit the Links section at
an income tax return with the federal healthyparentshealthychildren.ca/resources
government every year.

Birth certificate
A birth certificate is an important form of To learn more about registration of birth
identification used for government services and birth certificates, call Service Alberta
or when applying for other personal toll-free at 310-0000, then dial 780-427-7013
documents, like a passport. You do not (toll-free), or visit the Links section at
need to get a birth certificate for your baby healthyparentshealthychildren.ca/resources
right away. To get one, you’ll need to go to a
Registry Office and show your identification,
like your driver’s license or birth certificate.
There’s a cost for ordering a birth certificate.
Alberta personal health number

Your baby will be registered for a personal To learn more about the Alberta personal
health care number at the birth centre. health number, visit the Links section at
There is no cost to you. healthyparentshealthychildren.ca/resources
Alberta Child Health Benefit

Families living on a low income may qualify To get an application form, call toll-free at
for the Child Health Benefit for their child. 1-877-469-5437 or to print the form,
This benefit covers dental care, eyeglasses, visit the Links section at
ambulance services, diabetic supplies and healthyparentshealthychildren.ca/resources
prescription medicine. Your health care provider, pharmacist or a social
worker may also have these forms.
Income tax
Fill out and send in (file) an income tax If you haven’t filed your income tax in the last
return every year. If you have a partner, they year, or there’s been a change in your family
need to file one too. Your income tax return income, call toll-free at 1-877-469-5437.
will need to be filed before you can receive:
■■ the Canada Child Tax Benefit
■■ the Alberta Child or Adult Health Benefits
■■ other benefits, like the GST credit

Going home
Before you leave the birth centre:
Have you received a call from
■■ Check that the nursing desk has the your public health nurse?
correct phone number and address of
If you haven’t received a call from a
where you’re staying so the public health
public health nurse after 48 hours of
nurse can contact you within 1–2 days of being discharged, call Health Link at
leaving the birth centre. 811 to find the nearest community or
■■ Ask about any prescriptions you may public health centre.
need and have any questions answered.
■■ Fill out the Government of Alberta Registration of Birth form and leave it at the
nursing desk.
Your health care provider will discharge you and your baby from the birth centre. You can
keep your baby’s identification bands and card from their crib, cradle or bassinet.
Car seats
Using a car seat properly is required by law in
Alberta. Your baby is safest in a rear-facing car seat.
To install your baby’s car seat, follow the car seat
instructions and your vehicle’s owner’s manual.
Use the Rear-facing Car Seat YES Test to help you

properly install the car seat in your vehicle and
buckle up your baby correctly every time.
Borrowed or used car seats

Buying a used car seat is not a good idea.
Used seats may be missing parts, damaged,
recalled,or expired, and may not meet
current safety standards.
If you’re thinking about borrowing a car
seat, make sure you find out its history. Any
seat involved in a crash should be replaced.
There may be no signs of damage, but small
cracks or weakened areas can make the car
seat unsafe.

Take the Rear-facing Car Seat YES Test
A rear-facing seat provides the best protection for a child’s head, neck and back in a
sudden stop or crash. Using a car seat properly is required by law in Alberta. Use the
YES Test to help you properly install the car seat in your vehicle and buckle up your
baby correctly every time.
Push, pull and adjust the seat until you can answer “YES” to each item that
applies to your child’s car seat.
Who should be in a rear-facing car seat?

■■ A child is safest in a rear-facing car seat until they are at least 2 years old or reach
the maximum weight or height limit for the rear-facing seat (as stated by the
manufacturer).
■■ Rear-facing car seats that have higher weight and height limits are preferred and will
keep your child in the safer, rear-facing position beyond age 2.
Getting ready
❑ I’ve read the instruction booklet that came with the car seat.
❑ I’ve read the instructions in my vehicle’s owner’s manual on how to install a car seat.
❑ I’ve checked the labels on the seat to find the maximum rear-facing weight and
height limits. My child’s weight and height are under the limits.
❑ My child’s car seat is in the back seat.
❑ I never place the car seat in front of an airbag.
❑ My child’s car seat is approved to be used in Canada and has a Canada Motor
Vehicle Safety Standards (CMVSS) label.
Securing the car seat

There are 2 ways to secure the car seat:
Either:
❑ I’m using the Universal Anchorage System (UAS) to secure the car seat.
❑ I’ve checked my vehicle’s owner’s manual for the correct UAS anchor locations.
❑ The UAS belt goes through the rear-facing belt path on the car seat or base and
is attached to the UAS anchors.

Or
❑ I’m using the seat belt to secure the car seat.
❑ I’ve checked my vehicle’s owner’s manual for how to lock the seat belt for use
with a car seat.
❑ The seat belt goes through the rear-facing belt path on the car seat or base and
is buckled up.
❑ If the seat belt does not lock, I’ve used a belt lock or locking clip.
For either UAS or seat belt installation

❑ I’ve pushed down on the car seat or base and pulled the UAS belt or seat belt tight.
❑ The car seat moves less than 2.5 cm (1 inch) in any direction when pushed or
pulled.
Buckling your child in the car seat

❑ The slots that the harness straps go through are at or just below my child’s
shoulders.
❑ The chest clip is at the level of my child’s armpits.
❑ The shoulder harness is lying flat with no twists.
❑ The harness is snug—I cannot pinch a fold in the harness strap.
Being safe
❑ My child rides in the car seat every trip.
❑ If the car seat has a carry handle, I put it in the travel position.
❑ I’ve sent in the registration card for my child’s car seat and checked for recalls. To learn
more about car seats and recalls, call Transport Canada at 1-800-333-0510 or, visit
❑ If needed, I’ll get a larger car seat, with higher rear-facing weight and height limits,
so I can keep my child rear-facing as long as possible.
❑ When my child outgrows their rear-facing seat, I’ll move them to a forward-facing
car seat.
✓ If you answered “YES” to all of the statements, you’re ready for travel! If not, check
the instruction booklet for your car seat as well as your vehicle’s owner’s manual for
the exact installation instructions.

Your First Few Weeks at Home
Being a new parent can be wonderful. Like other big
changes in your life, it can also be challenging. In the
first few weeks after giving birth, many new parents
are surprised to find that looking after their baby
takes most of their time and energy. You may feel
tired, excited, anxious, irritable, happy or confused.
You’ll be learning many things and going through

a lot of changes. This is a time to focus on yourself
and your baby. Do not worry about trying to get
anything else done in these first few days and weeks.
When you take care of your physical and emotional
health, you’ll be better able to take care of your baby.
Sometimes people will offer to help and

sometimes you’ll need to ask them. Be kind If you’re a partner
to yourself—it’s okay to accept and ask New mothers recovering from birth
for help. You may want to have family and will need your support. You’re also
friends help by cleaning the house, making going through lots of changes
meals, looking after your other children, yourself. Focus on yourselves and
pets or animals or running errands so you your baby. Ask for help from others
if you need it.
can have more time with your baby. You
“
may also want to ask them to help with your
baby so you can have a rest.
Learning to ask for help and
It’s normal to have lots of questions and accepting help can seem odd at
to feel unsure when you’re a new parent. first, but it’s all part of being in
Trust your instincts. It helps your baby feel
a community. I remember how
comfortable, loved and safe when you:
good I felt when I brought dinner
■■ Feed them when they’re hungry. to my friend who had a baby,
■■ Cuddle them often, using skin-to-skin as and how grateful she was. If that
much as possible. is the way I felt, then of course
■■ Let them see, smell, feel and hear you. others do really want to help
”
■■ Smile and gently talk to them. you when you need it. Everyone
benefits and feels good!
■■ Pick them up when they cry.
~ Andraya, mom of one child

Public health nurse
Your public health nurse will call you soon after you leave the birth centre. The nurse may
arrange to see you to:
■■ Examine you and your baby. ■■ Take out any stitches or staples if you’ve
■■ Help you with feeding your baby. had a caesarean birth or tell you where to
have them removed.
This is a good time to ask questions about:

■■ how your family is adjusting to having ■■ parenting in general
your baby at home ■■ resources in the community
■■ how to keep your baby safe ■■ immunizations for you, your baby and
■■ sexual health including birth control other family members
■■ your emotions
Your public health nurse will also arrange followup care, if needed.
Doctor or midwife
Ask your doctor when you should book an
appointment for both you and your baby. If
you do not have a family doctor, now is the
time to get one (see page 24).
At your appointment, your doctor will check

your general health, talk about birth control,
how you’re adjusting to your new baby, and
offer you a PAP test, if you are due for one.
Your baby should also see your doctor in the first few days after birth, to check how your
baby is feeding, their weight, and for jaundice. Your doctor will also assess your baby at
your check-ups and let you know how often they want you to come in for checkups.
If you were cared for by a midwife in your pregnancy and labour and birth, they will also
care for you for the first 6 weeks, including home or clinic visits at around 2 and 6 weeks.
After 6 weeks, you and your baby will return to your family doctor.
This is a chance to get any questions you have answered. You may want to talk about birth
control (see page 257).
jaundice: yellowing of the skin and whites of the eyes due to high bilirubin levels

Many of the physical and emotional changes that happen with pregnancy will last for
several months after your baby’s birth. In the coming weeks and months you’ll also be
balancing your responsibilities as a parent. You’ll need to give yourself time to recover from
pregnancy and birth—pace yourself. It will also take time for you to be comfortable in your
new role as a parent. Looking after yourself will help you take care of your baby so that you
can enjoy your time together. This also helps to create a healthy family environment that
you and your family can thrive in.
“ ”
You might not get a whole night off, but if you can fit in 15 minutes for a
shower, that’s important.
~ Quy, mom of a toddler
Caring for yourself

Showering and bathing
If you had a vaginal birth, you can shower or have a bath as soon as you feel you’re able to,
unless your health care provider tells you otherwise. Make sure your bathtub is clean before
you have a bath to help prevent an infection in your vagina and uterus. You may also want
to have someone help you get in and out of the bathtub. If you’ve had a caesarean birth,
see page 236.
Breast and nipple care

Within a couple of days after birth, your breasts will become larger and heavier. They may
feel tender and fuller—your breast tissue swells when your body starts making more milk.
The swelling will go away over time.
If you’re breastfeeding and want to learn more about breast and nipple care, see page 308.
If you’re not breastfeeding, your breasts may become painful and overfill with milk
(engorged). They may be hard, swollen, red and painful. Here are some comfort measures
to try:
■■ Wear a supportive bra for comfort until your breasts produce less milk, usually in
5–10 days. Do not wear a bra that’s too tight or that binds your breasts.
■■ Put ice packs wrapped in a cloth on your breasts for 20 minutes at a time.

Let your breasts leak milk while
■■
showering. Call Health Link at 811 or your

health care provider if you have
■■ Express or pump a very small amount
!
any of the following:
of milk for comfort as needed. If you
express too much milk, your body will ■■ your breasts become hard, red
and painful
make more milk.
■■ you have a fever of 38 °C (100.4 °F)
■■ If your breasts are painful and swollen,
or higher
take a mild pain medicine as recom-
mended by your health care provider.
Medicine to dry up breastmilk is seldom prescribed anymore. Possible side-effects include

very bad engorgement, headaches and blood clots in the legs. Talk with your health care
provider about other ways to help with your discomfort.
Normal vaginal discharge

You’ll have a bloody discharge or flow (lochia) from your vagina after your baby is born.
The flow, which can last up to 6 weeks, is caused by your uterus shedding its lining.
■■ For the first 1–3 days your flow will be heavy and bright, then it will turn dark red.
You may need to change your pad every 1–3 hours. You may also pass a few small
blood clots no bigger than 2 cm (¾ inch). Some women pass no clots at all.
■■ During days 4–10, your flow will be lighter each day and be brownish or pink. You’ll
need to change your pad every 3–5 hours or every time you go to the bathroom.
■■ After 10 days and until about 2–6 weeks, your flow will be yellowish white.
It’s normal for your flow to be heavier

during and after breastfeeding, after Call 911 NOW if you feel
activity and after sitting or lying down for lightheaded and have heavy,
a while. This is because mild contractions
in your uterus are helping get rid of its
lining. If your flow gets a lot heavier after
!! fast or steady bleeding from
your vagina that overflows
your pad, runs down your
activity, it may be a sign that you’re doing legs or forms a large pool.
too much. Rest if your flow gets heavier.
Your flow should slow once you stop
doing the activity.

Call Health Link at 811 or your health care provider if you notice any of
the following:
■■ in the first 3 days, you
pass a blood clot larger than 2 cm (3/4 inch) and are soaking 1 sanitary pad
(heavy blood flow) in less than 1 hour
soak 1 pad in less than 1 hour
■■ after 3 days, you
pass a blood clot larger than 2 cm (3/4 inch) and are soaking 1 pad in less
than 3 hours
! ■■
■■
soak 1 pad in less than 3 hours
a slow and steady flow of blood from your vagina
flow that is not getting any lighter
■■ flow that turns bright or dark red after it’s changed to brownish pink or
yellowish white and you start to bleed heavily
■■ flow that smells bad, even with regular pad changes
■■ sharp and stabbing pain in your abdomen
■■ a fever of 38 °C (100.4 °F) or higher without chills or aches for more than
2 days
■■ any other symptoms that concern you
Perineal care and comfort

Your perineum may be very sore for the first few days after a vaginal birth. Do perineal
care until your vaginal flow stops.
Here are some things you can do to keep you more comfortable and help your
perineum heal:
■■ For swelling or bruising, wet a feminine pad by running water down the centre of it,
and then place it in the freezer. Wrap the frozen pad in a thin cloth and place it on your
perineum for 20 minutes at a time during the first 24 hours. Do not re-use frozen pads.
■■ Lie on your side or back rather than sitting when you rest, sleep or feed your baby.

Try taking a warm bath in a clean tub, unless your health care provider tells you
■■
otherwise. Sitting in a shallow bath with warm water can help soothe, clean and heal
your perineum. You can do this twice a day for up to 20 minutes at a time. Use clean,
warm water with no soaps, oils or bubble bath. You can add Epsom salts to the water as
per the package instructions.
■■ To help prevent infection, do not use tampons or menstrual cups for the first 6 weeks
after having your baby.
■■ Drink plenty of fluids and eat foods high in fibre to prevent constipation (see page 36).
■■ If you’re breastfeeding, talk with your health care provider about taking pain medicine.
The medicine that they recommend will be safe for your baby. Usually only a small
amount of this medicine will pass to your baby through your breastmilk.
■■ Until your flow is done, pour warm tap water over your perineum from a clean squeeze
bottle, every time you go to the bathroom.
■■ Wash your hands before and after changing your pad and any time you go to the
bathroom.
■■ Gently dry your perineum with toilet paper, patting dry from front to back.
■■ Change your sanitary pad each time you go to the bathroom, or at least every 4 hours.
■■ Do not touch the surface of your sanitary pads. This will keep them as clean as possible.
If you have an incision from an episiotomy, the stitches will dissolve on their own and will
likely heal in 2–4 weeks. You may notice small pieces of the stitches on your pad as your
body heals.
To learn more about the changes that can happen after vaginal and
caesarean births, and what to expect in terms of healing, getting
back to exercising, and sexual intercourse, visit the Videos section at
Call Health Link at 811 or your health care provider, if:
!
■■ your perineum doesn’t feel like it’s getting better
■■ you’re developing signs and symptoms of an infection, such as a fever
of 38 °C (100.4 °F) or higher, chills, more swelling in your perineum and
vaginal flow that smells bad

Menstrual period
If you’re breastfeeding, your menstrual period may not start again for a few months or until
you breastfeed less often or stop completely. If you’re formula feeding or not exclusively
breastfeeding, your period will usually start 4–9 weeks after birth. Your first menstrual
period may be longer, shorter, heavier or lighter than usual.
You can still become pregnant again before you get your first period. This is because your
ovaries release an egg (ovulate) before your first period starts. For this reason, talk with
your health care provider about your choices for birth control, before you become sexually
active again (see page 257).
Comforts for other physical changes

Your body goes through many changes in the first few days after birth. Here are some of
the physical changes you can expect and what you can do about them.
After pains
Physical changes
■■ Your uterus will continue to contract as it ■■ The after pains may feel more painful
returns to its pre-pregnancy size. These when you breastfeed. This is because the
contractions are called ‘after pains’. This hormone that releases milk from your
helps your uterus stay firm and your vaginal breasts is the same one that contracts your
bleeding stay within normal limits. uterus.
■■ After pains may feel like menstrual cramps. ■■ After pains should start going away in
They may be stronger if you’ve given birth 3–5 days.
before.
■■ Put a warm water bottle on your abdomen.

■■ Take pain medicine as recommended by your health care provider.
■■ Try relaxation breathing.
!
■■ your pain feels worse, even after using comfort strategies
recommended by your health care provider
■■ nothing seems to manage your pain
■■ your abdomen is tender when touched

Bowel movements
Physical changes
■■ You can expect to have a bowel movement within 3 days of your baby’s birth.
■■ Drink plenty of fluids and eat foods high in fibre (see page 36).
■■ Do gentle activity, such as going for a short walk, every day, if you can.
■■ Take a stool softener if recommended by your health care provider.
!
■■ you feel you need to have a bowel movement, but you can’t
■■ your bowel movements are painful and hard
■■ you haven’t had a bowel movement 3 days after your baby’s birth
and you’re in pain
Hemorrhoids
Physical changes
■■ Hemorrhoids are enlarged blood vessels that can occur both inside and outside the rectum.
■■ Hemorrhoids are caused by increased pressure from your baby on your abdomen, hormone
changes, labour and birth of your baby. They usually shrink and hurt less over time.
■■ Put ice packs wrapped in a cloth on your ■■ Position yourself on the toilet so you do
anal area or wet and freeze a sanitary pad, not strain. Keep your back straight and put
wrapped in a thin cloth, to use as an ice a small stool under your feet so that your
pack for 20 minutes every 4 hours for the knees are higher than your hips.
first 4 days. Do not reuse frozen pads. ■■ Take a warm, shallow bath for no longer
■■ Use warm water from a clean squeeze than 20 minutes.
bottle to clean your anal area after having a ■■ Take medicine recommended by your
bowel movement. health care provider.
■■ Lie down and rest whenever possible. ■■ Sit on a soft pillow for more comfort.
■■ Try not to stand or sit for too long. ■■ Drink plenty of fluids and eat foods high in
fibre (see page 36).

! your hemorrhoids prevent you from having a bowel movement

■■
■■ your hemorrhoids are very painful or hard

■■ you’re bleeding from your rectum
Passing urine
Physical changes
■■ Your body stores extra fluid while you’re pregnant. After birth, your body gets rid of this extra
fluid by making more urine.
■■ If you have stitches or small tears in your perineum, it may sting as you pass urine.
■■ Pour warm water from a clean squeeze bottle over your perineum as you pass urine.
■■ Drink plenty of fluids.
■■ Try to pass urine at least every 4 hours.
■■ Do pelvic floor exercises as soon as you’re able to tolerate it. If you’re able, start within 24 hours
of having your baby with gentle, short, pelvic floor muscle squeezes, as long as there is no
pain or other symptoms. Doing them early will help to reduce any swelling and speed up the
healing process (see page 49).
Call Health Link at 811 or your health Go to the
!!
care provider, if: emergency
■■ you have difficulty passing urine department NOW
if you cannot pass
■■ you’re passing urine often, but only
urine.
in small amounts
! ■■
■■
it hurts or burns when you pass
urine
you notice blood when urinating
■■ you have trouble starting or
stopping the flow of urine
■■ you have a fever of 38 °C (100.4 °F)
or higher

Urinary and bowel incontinence
Physical changes
■■ Weak pelvic floor muscles can lead to the accidental release of urine, stool or gas.
■■ Pregnancy and birth are the most common causes of a weak pelvic floor.
■■ Do pelvic floor muscle exercises to ■■ Limit the amount of caffeine you drink.
help prevent and treat urinary or bowel ■■ Drink plenty of fluids and eat foods high in fibre
incontinence (see page 49). (see page 36).
■■ Tighten the pelvic floor muscles before ■■ Keep track of your symptoms and
you lift your baby, cough, or sneeze to any urine or stool you leak with a
help prevent leaking. bladder and bowel diary. This will
■■ Go to the bathroom every 3–4 hours to help you and your health care
help prevent leaking urine. provider find the best treatment.
To learn more, visit the Links section at

■■ you’re having ongoing back, pelvis, groin or abdominal pain
!
■■ you’re leaking urine or stool while laughing, coughing, sneezing, lifting,
or walking
■■ you have a bulge in your abdomen when you exercise
■■ you’re having trouble doing any of your everyday activities because of
pain, leaking or pressure

Pelvic organ prolapse
Physical changes
■■ The bladder, uterus and rectum can shift and sag towards the vagina after birth.
■■ This can be mild and not cause any symptoms or it can cause bulging, heaviness and
problems emptying your bladder or bowel.
■■ Having a baby can often start pelvic organ prolapse. It’s very common and tends to get worse
as you get older.
■■ Use healthy posture (see page 50). ■■ Do not push to pass urine.
■■ Be careful with activities or exercises that ■■ Slowly reach and stay at a healthy weight.
raise the pressure in your abdomen, such as Extra weight pushing down on the pelvic
heavy lifting. floor can make prolapse worse.
■■ Return to physical activity gradually. ■■ Do pelvic floor muscle exercises every
day (see page 49). This will help make the
■■ Do not hold your breath when lifting.
pelvic floor muscles stronger so they can
■■ Drink plenty of fluids and eat foods high offer support and will help lower the risk of
in fibre to help prevent constipation pelvic organ prolapse.
(see page 36). Straining and pushing can
make prolapse worse.

■■ you’re having a hard time starting the flow of urine or a bowel movement
!
■■ you’re leaking urine or stool while laughing, coughing, sneezing, lifting,
or walking
■■ you have a bulge in your abdomen when you exercise
■■ you’re having trouble doing any of your everyday activities because of
pain, leaking or pressure

Night sweats
Physical changes
■■ You may sweat more, mostly at night during the first week after your baby’s birth. Your
temperature should be normal.
■■ Wearing cotton clothing may keep you more comfortable.
!
■■ you have any other signs of illness, such as feeling flu-like symptoms that
include a fever of 38 °C (100.4 °F) or higher, chills, and body aches
Swollen feet, ankles or calves

Physical changes
For a few weeks after your baby’s birth, extra fluid may collect in your feet, ankles and calves.
■■ Sit with your feet up as often as possible— ■■ Try not to cross your legs when sitting.
use a stool or raise your legs up on a pillow ■■ Change your position often and do not
at the foot of your bed when lying down. stand in one spot for too long.
■■ Try not to sit for long periods of time. ■■ Drink plenty of fluids.
■■ Wear loose clothing. ■■ Do some walking.
■■ Do not wear ankle or knee socks—
compression stockings are okay.
Call Health Link at 811 or your health Call 911 NOW if

care provider, if: you have any of
!!
one foot, ankle or calf becomes more the following:
!
■■
swollen than the other ■■ trouble breathing

■■ you have a red, painful and hot lump ■■ painful breathing
in your lower leg—do not massage it ■■ chest pain
■■ one of your lower legs are throbbing,
tender or ache

If you’ve had a caesarean birth
After a caesarean birth, you’ll have an incision on your lower abdomen. This area will likely
be very sore. You may:
■■ see small amounts of blood or pink fluid
!
coming from your incision Call Health Link at 811 or your
health care provider if your
■■ feel after pains (see page 230)
incision has opened up.
■■ feel gas pains
■■ have bruising around or along your incision
You’ll have staples or stitches holding your incision closed. The staples or stitches are
usually taken out 3–5 days after surgery. Most stitches are dissolvable. They will take
1–2 weeks to dissolve and won’t need to be removed. After your staples are taken out,
your health care provider may put on paper tape to support your incision.
Your health care provider will let you know when you can shower and provide you with
any other instructions. Keep your incision clean. When you do shower, let soapy water run
down your body over your incision and pat it dry with a clean towel when you’re done.
Do not scrub or rub your incision as this might pull out the staples, stitches or paper tape
before the incision has healed enough. Wait until your incision has healed before you have
a bath.
“ The best trick for a father whose wife has had a caesarean birth is to plan and
strategize everything. Like the next days’ meals, water in the kettle, toilet-seat
down, laundry, changing station prepped. Make sure there’s nothing on the
”
floor that will be stepped on and kicked in the night, because you’ll be up in the
night. Oh, yes...you’ll be up! Since you’re up, you may as well start cleaning.
~ Serge, dad of a toddler

Healing from a caesarean birth
It can take up to 6 weeks for your incision to
fully heal. While it’s healing: Extra help
If you had a caesarean birth you’ll
■■ Only lift things that weigh as much as or less
need some extra help. Ask your
than your baby. partner or support people for help
■■ Hold a pillow firmly to your abdomen when when you need it.
you stand up or move around in bed.
■■ Support your abdomen by holding a pillow near the incision during sudden
movements, coughing, sneezing or laughing.
■■ To get up from lying down, roll onto your side, then push yourself up to a sitting
position.
■■ Take pain medicine as directed by your health care provider. Your pain should become
less over time.
■■ Try different positions that feel more comfortable for breastfeeding, such as laid back or
lying down (see page 282). Ask your health care provider to help you find comfortable
positions.
■■ Drink plenty of fluids and eat foods high in fibre to help prevent constipation
(see page 36).
Talk with your health care provider about when you can re-start physical activity and when
you can drive again after your caesarean birth. Ask someone to help you carry and install
your baby’s car seat while you’re healing so you do not hurt yourself.
Call Health Link at 811 or your health care provider if you notice any of
the following:
■■ oozing or blood coming from your caesarean incision
!
■■ yellow or green discharge coming from your incision
■■ red, hot and tender areas around your incision
■■ increasing pain in your uterus
■■ severe pain in your incision with no relief from pain medicine and rest
■■ a fever of 38 °C (100.4 °F) or higher

Healthy eating and physical activity
Eating regularly and following Canada’s Food Guide will help give you the energy you need
to care for yourself and your new baby. It can also help with your mental health. Keep
taking a daily multivitamin with 0.4mg (400 mcg) folic acid and vitamin D (400 IU). If you
still have prenatal multivitamins, you can use these up first.
“ Get up and walk as soon as possible. I found that

once you’re walking you start to feel better. Find a
”
motivation— mine was to get to the NICU and see
my son.
~ Katie, mom of a newborn
Being active after pregnancy can help you cope better with stress, and improve your
mental health. If you didn’t have any complications with your pregnancy and birth, you
can start some low-impact activity right away, such as pelvic floor muscle exercises and
gentle stretching. Pelvic floor muscle exercises are especially important after birth to
reduce the risk of urinary problems later on and to get back the tone and control of your
pelvic floor (see page 49).
Start activity slowly and give your body time to heal. How soon you can get back to your
normal physical activity depends on how long and how hard your labour was and if you
had a vaginal or caesarean birth. Most activities can be started at a lower intensity and for
shorter amounts of time.
Talk with your health care

provider about when you can:
■■ re-start activities, including
everyday lifting and
carrying
■■ start doing activities that
involve abdominal muscles,
such as sit-ups or rotating
your upper body and
bending to the side

Taking care of yourself and slowly becoming more active again will give you the energy
you need for your growing family. When you’re active, you also help set a good example
for your child for the rest of their life. To learn more about physical activity for
adults, visit the Links section at healthyparentshealthychildren.ca/resources
Walking
Walking is a safe and effective way to get moving. It’s also good for your body and spirit.
All you need is a pair of shoes. Ask your partner, a family member or a friend to join you.
Take your baby with you in a carrier or stroller, or ask someone else to look after your baby
while you go for a walk.
■■ Start walking for 10–15 minutes, at a pace
where it’s easy for you to have a conversation. Winter safety
■■ For the next 5–10 minutes, walk at a pace Stay safe while walking in
where it’s harder for you to have a conversation. the winter by wearing proper
footwear, walking slowly, and
■■ Finish by walking at the pace you started with. taking small steps. For slippery
■■ Try to walk most days. conditions, consider ice grippers.
Postpartum weight loss

How quickly you lose weight after your baby is born will depend on what you eat, your
level of physical activity and how much weight you gained during pregnancy. You might
lose weight more quickly in the first few months after your baby is born and slow down
later on. Be patient—it can take time and it’s normal for your weight loss to be gradual.
Try to get to a healthy body weight after your baby is born. When you’re at a healthy
weight you’re at less risk of health problems such as diabetes, high blood pressure, high
cholesterol, stroke and certain types of cancer. Being at a weight that is healthy for you can
also help you have a healthier pregnancy in the future if you’re planning to have another
baby. Eating well and being active can help you get to a healthy weight. Do not follow
strict weight loss diets or cut out entire food groups. Each food group is important and
gives you the nutrients your body needs.
To learn more about postpartum weight loss, talk to your health care provider
or, visit the Links section at healthyparentshealthychildren.ca/resources

Rest and sleep
During the first few weeks after your baby’s
born, rest and sleep are important to help
your body heal. This will help you get your
strength back, manage your feelings and
cope with any challenges.
To help you get the rest and sleep that

you need:
■■ Use feeding time as a chance to rest. Take
care not to fall asleep while feeding your
baby. If you’re feeling sleepy, put your
baby on their back in their own crib,
cradle, or bassinet.
Rest leads to recovery
■■ Sleep when your baby sleeps.
It can take a few weeks or more
■■ Ask for and accept offers of help. before you start feeling more rested.
It can take even longer if there were
■■ If you’re breastfeeding, try different
complications at birth, such as you lost
breastfeeding positions, such as laid back
a lot of blood or had a caesarean birth.
or side lying (see page 282). Rest or have
a nap after feeding. Hormones released
during breastfeeding often make you feel sleepy.
“ Any support and votes of confidence from friends and family mean a lot in
the first few weeks. People saying, ‘You guys will get through it’, ‘Here’s some
”
food!’, ‘Let me take the kids for a walk and you can take nap’, made us feel so
much better.
~ Andy, dad of two children
Preventing injuries
To prevent injury, take care when lifting, carrying and using a work surface like a
change table.
■■ When lifting, bend your knees, keep your back straight and lift with your leg muscles.
■■ Take your baby out of their car seat before carrying them, whenever you can.
■■ Carry your baby in front of you and not over your shoulder, as it puts more strain on your
lower back.

Keep supplies close by so you do not have far to reach.
■■
■■ Set your stroller or baby carriage handles high enough so you do not need to
bend forward.
■■ Kneel or squat when working at floor level—bend your knees, not your back.
■■ Use a work surface that’s near the level of your hip bone.
Baby and child carriers

Using carriers properly will help prevent you from getting back and neck strain and keep
your baby safe. Follow the manufacturer’s instructions carefully. During the first few
months, when babies have poor head control, they need to be carried facing you and in
front of you. Avoid activities like running, cooking and drinking hot beverages while using
a sling or carrier to help reduce the risk of injuries.
When carrying your baby on your front using a sling:

■■ Choose a sling that holds your baby
upright—they’re safer.
■■ Have someone help you put your baby in
the sling the first few times you use it.
■■ Make sure your baby’s face is uncovered.
When carrying your baby on your front

using a carrier:
■■ Have your baby sit high on your chest,
with their head under your chin and their
face uncovered.
■■ Carry your baby up higher to prevent you
from being pulled forward and down.
To learn more about carriers, slings and

safety recalls, visit the Links section at
Bike carriers and trailers

Bike carriers and trailers are not safe for
babies under 1 year of age because they
have poor neck and head control.

Visitors
Friends and family will want to visit and meet your baby. While having visitors can be nice
to share the joys of your new baby, it can also be very tiring, especially in the first few
weeks. You and your baby need time to get to know each other and adjust to the changes
in your lives, so do not feel bad if you need to limit how often and how long visitors can
come over for a visit.
■■ Ask visitors to come at a time that works for you and do not be afraid to let them know
when you’re getting tired and need to rest.
■■ Ask visitors to wash their hands or use an alcohol hand gel before touching or holding
your baby.
■■ If they’re sick with a runny nose, cough, fever, rash or upset stomach, ask them to come
for a visit when they’re healthy again.
■■ If they come to visit without calling you first, decide whether you want to see them. If it
doesn’t work for you and your family, say it’s not a good time and let them know when
would work better.
■■ Ask visitors to leave if they’re staying too long. You can say it’s time for you and your
baby to have a rest.
■■ Resist the urge to clean the house for visitors. Remember, they’re coming to see you and
your baby.

Control the spread of germs
A clean environment means a lower risk of infection for everyone in the family. Here are
some simple things you can do to control the spread of germs.
What Wash your hands.

Make sure everyone who holds or touches your baby washes their hands first.
How ■■ Use plain soap and water—not antibacterial soap. If using refillable soap pumps, clean
the soap bottle and pump before re-filling.
■■ You can also clean your hands with an alcohol hand gel if you do not see any dirt on
your hands.
■■ Wash your hands (see page 38):
if they’re dirty
before preparing or eating food
before holding or feeding your baby
after using the bathroom, changing a diaper or helping a child use the toilet
after you’ve sneezed, coughed or wiped your child’s nose
after handling pets or animals
■■ Use a separate clean cloth or towel for each person, when someone in the family is
sick.
Why ■■ Washing your hands is the best way to stop spreading germs. Most germs that make
people sick are passed to others by touching.
What Keep sick people away from you and your baby.
How ■■ If someone is sick with a runny nose, cough, fever, rash or upset stomach, ask them to
stay away until they’re healthy again.
Why ■■ While these illnesses may be a smaller problem for older children and adults, they
could make your baby very sick.
What Do not share items, like soothers, spoons or bottle nipples that anyone, including
you, has had in their mouth with your baby.
How ■■ Bacteria can be passed to your baby if items with someone else’s saliva on them are
shared and put in your baby’s mouth.
Why ■■ Babies do not have all of the immunity that adults do, so bacteria and viruses can be
passed to your baby and make them very sick.
■■ Bacteria that causes tooth decay can also be passed to your baby.

Mental health
The first few days and weeks after your
baby is born are often filled with many
emotions. Feelings of excitement and joy
are often mixed with feelings of worry and
tiredness. Your sense of who you are may
have changed throughout your pregnancy
and birth.
You may find that you:

■■ have mixed feelings about no longer
being pregnant, your birth experience,
your baby, or your role as a parent
■■ have a lot of energy or feel very tired Talk about your feelings
■■ have emotions that go from happy to sad Whether you’re parenting with
and back again a partner or on your own, talk to
someone you trust about your feelings.
■■ feel differently about how you look and
the changes your body has gone through
Pay attention to your feelings and talk to your partner or your support person. You may be
surprised to find that they also have mixed feelings.
Self-care
Coming home with your new baby may be an adjustment. Caring for your baby, changes
in sleep and emotions can all affect how you feel and cope. Taking care of yourself, both
mentally and physically, is one of the most important things you can do for yourself. This
will help you have the energy you need to take care of your baby.
Practicing these self-care tips may help your mental health by reducing stress and giving
you the energy you need to cope with change, solve problems and manage your feelings
and emotions.
■■ Take things one step at a time and one How to tell if you’re stressed
day at a time. When your body is stressed it may
■■ Drink plenty of fluids, eat regularly and make you feel sad, worried, tense,
follow Canada’s Food Guide. nervous or angry. Your body may react
to stress with tiredness, headache,
■■ Be active. Even going for short walks can backache, stomach ache or a rash.
help boost your energy and mood.

Take a nap or rest when your
■■
baby sleeps.
■■ Talk about how you’re feeling
with someone who will listen
without judging and who can
offer you support.
■■ Write down your thoughts or
feelings in a journal or in this
book.
■■ Take time for yourself, even
if it’s just for short periods
of time to help you feel
refreshed.
■■ Practice simple relaxation ■■ Stay connected with your family
techniques such as deep breathing and and friends.
distraction (see page 246). Taking short ■■ Limit visitors if you’re tired. Decide when
relaxation breaks throughout the day can visitors can come and do not be afraid to
be really helpful. let them know when you’re getting tired
■■ Ask for and accept help from others. and need to rest.
■■ Say no to any household tasks that are ■■ Go to parenting classes and support
not urgent. groups. They can help you meet people
who may be going through the same
■■ Spend time with your partner.
things as you.
Be kind to yourself—caring for a new baby is a lot of work. No new parent has all the
answers—you’ll learn as you go. Take the time to enjoy getting to know your baby. It’s your
smiles, gentle voice, facial expressions and the gentle touch you provide as you help your
baby meet their needs (e.g., feeding, sleeping, changing diapers) that build the connection
needed for healthy attachment. Take your time and enjoy the journey.
You may be surprised that your life has

Caring for yourselves changed significantly with your baby’s
Remember that caring for your needs birth. You’ll find it takes time to adjust
is important too. Your baby needs to this new normal. You may find that
parents who take care of themselves to you’re worried about your baby’s health
create a healthy family environment to and safety, your ability to protect and
grow and thrive in.
care for them or about yourself. You may
also be worried about less income as

you stay home with your baby, less time for other activities and relationships. Talk about
your concerns with your partner or someone else you trust. To learn more about what
you can do for yourself in tough times and where to get help, visit the Links section at
Relaxation technique
Get comfortable. Lie down or sit with your feet up. Then:
1. Take 4–5 deep breaths—in through 4. When you get to your head, breathe
your nose and filling up your abdomen, deeply 4–5 more times. Let go of all of
and out, slowly through your mouth. your tension.
This is like pretending you’re blowing 5. Now, imagine a favourite place. Imagine
on a candle, and trying to flicker the you’re in that place and stay there a
flame, but not blow it out. while. Enjoy the feeling in your body
2. Think about sending the tension out of and the calm in your mind.
your body each time you breathe out. 6. When you’re ready, slowly bring
3. Starting with your toes, relax each part yourself back to the present. Take a
of your body. Relax your way up, from moment to enjoy how you feel.
your toes to your head.
Over the next few months, as you get to know your baby better, you’ll start to feel more
confident in your abilities to take care of them and your family. However, you may continue
to have mood changes. Birth moms are not the only ones who can have mood changes.
All parents, including dads and parents who adopt a baby, can have depression or anxiety.
If you or your partner have had depression, anxiety or other mental illness before or have
these symptoms now, talk with your health care provider.
Postpartum blues (baby blues) Depression

Many moms get the ‘postpartum blues’ around the and anxiety
3–5 days after their baby is born. Postpartum blues are All parents can have
linked with hormone changes associated with pregnancy depression and anxiety.
and after childbirth. Getting support from people close to
you and getting plenty of rest may help you deal with the postpartum blues if you have it.
If you have postpartum blues, you may:

■■ feel a little sad, restless, anxious or ■■ have trouble concentrating
overly sensitive ■■ feel overly tired or have trouble sleeping
■■ cry for no reason ■■ find your mood changes often, such as
■■ be impatient and irritable going from feeling happy to feeling sad

Having the postpartum blues is common and may last 1–2 weeks. If these feelings do not
go away or if they get worse, it may be a sign of postpartum depression or anxiety. If you’re
struggling, you’re not alone.
If you’re a partner Call Health Link at 811 or your health

Pay attention to each other’s
feelings and emotions and
talk about them.
! care provider if you have symptoms
of postpartum blues that last longer
than 2 weeks after your baby is born.
Postpartum depression, anxiety and psychosis

Postpartum depression or anxiety can happen anytime up to one year after your baby is
born—even if it didn’t happen with your other births. If you’ve had depression or anxiety
before or during your pregnancy, this can increase the chances of having postpartum
depression. Postpartum depression and anxiety are common after birth and often occur
together. Your partner may be the first one to notice the symptoms.
When you take your baby to their first immunization appointment at two months, a public
health nurse will offer to screen you for postpartum depression. Untreated postpartum
depression can affect your relationship with your baby, partner and family. This includes
your ability to take care of yourself and your baby. People may tell you to ‘pull yourself
together’, but postpartum depression is not something that goes away on its own.

Symptoms of postpartum depression
Behaviours Thoughts
■■ not coping with things that you used ■■ “I’m a failure.”
to be able to handle ■■ “It’s my fault.”
■■ starting things and not finishing them ■■ “Nothing good ever happens to me.”
■■ avoiding places, people, family and ■■ “I’m worthless.”
friends
■■ “Life’s not worth living.”
■■ not doing things you used to enjoy
■■ “People would be better off without me.”
■■ having trouble concentrating or
making decisions ■■ “I wish I were dead.”
■■ using alcohol or drugs to feel better
Feelings Physical symptoms

■■ overwhelmed or hopeless ■■ tired all the time, sluggish or lethargic
■■ useless or not good enough ■■ trouble sleeping—either too much or
■■ irritable, restless or agitated too little
■■ frustrated or miserable
■■ sick, run down or no energy
■■ unhappy or sad
■■ headaches or muscle pains
■■ empty or numb
■■ upset stomach
■■ frequent mood changes

■■ changes in appetite—eating more or less
! Call Health Link at 811 or your health care provider if you or your
partner notice any symptoms of postpartum depression or anxiety.
!! Call 911 NOW if you or your partner have thoughts of hurting

yourselves (suicide), hurting your baby, or of hurting anyone else.
“ When I was struggling after my second was born I wish someone had told me
that even though it seemed deep and dark and like it wouldn’t end, it DID end.
”
It doesn’t last forever, it will get better, and it definitely does not define you as
a parent.
~ Elena, mom of three children

Symptoms of postpartum anxiety
Behaviours Thoughts
■■ having trouble sleeping ■■ feeling scattered or having trouble
■■ avoiding people, places or responsibilities concentrating
■■ starting things and not finishing them

■■ thinking about the worst
■■ pacing, fidgeting or being restless

■■ easily distracted
■■ re-checking things often such as if the

■■ having problems remembering things
house is locked
■■ using alcohol or drugs to feel better

■■ tense, stressed or uptight ■■ tight or painful chest, feeling like your
■■ panicky, unsettled or irritable heart is pounding
■■ things do not seem real or they feel

■■ dizziness, sweating or shaking
strange ■■ nausea or upset stomach
■■ feeling that something bad is going to ■■ body aches or tense muscles
happen
You may think that this is not how you’re supposed to feel or it’s not what you expected.
You may also be worried about talking to your partner or someone about these feelings. If
you feel this way, you’re not alone.
Getting help when you first notice the symptoms of depression or anxiety is important.
Asking for help doesn’t mean you’re weak, or that you’re not a good parent. The earlier
you ask for help, the sooner you can get the support you need, and the sooner you’ll
start feeling better. Seeking help and practicing self-care can decrease your symptoms of
depression and anxiety.
To learn more about postpartum depression or anxiety, and getting help, visit
“ Talk and reach out to people—there are groups, supports, and friends.
”
Know it doesn’t mean that you’re a bad person or a bad parent. It means that
you need support and that’s okay. That’s what we all need at some point.
~ Hana, mom of a preschooler

While postpartum psychosis is rare, it’s very serious and can happen quickly—usually in
the first month after your baby is born. Get help right away as this is a medical emergency.
There’s a high risk of a mother with postpartum psychosis harming herself or her baby.
Symptoms of postpartum psychosis
Behaviours Thoughts
■■ unpredictable or unusual behaviour ■■ being very confused, forgetful and
that’s not like the mother at all having mixed up thoughts
■■ being very agitated, talking very fast ■■ beliefs that are not based in reality
and not being able to focus (delusions)
■■ seeing or hearing things that are not
there (hallucinations)
Feelings Physical symptoms

■■ feeling super strong and powerful or ■■ not being able to sleep
very depressed ■■ often pacing, even for long periods
■■ feelings range from highest of highs to of time
lowest of lows
Call 911 NOW if:
!! ■■
■■
your partner has thoughts of suicide or hurting themselves,
your baby or anyone else
your partner has symptoms of postpartum psychosis
Alcohol
Canada’s Low-Risk Alcohol Drinking Guidelines recommend
If you’re
not drinking any alcohol when you’re responsible for the
breastfeeding
safety of others—when you drink alcohol, you may not be If you choose to drink
alcohol or use tobacco,
able to properly supervise and care for your baby.
cannabis or other drugs
For both men and women, alcohol can affect your overall while breastfeeding,
talk with your health
health. Following the low-risk drinking guidelines can
care provider about
reduce the risk of many long-term health problems. To learn
how to reduce your
more about the low-risk drinking guidelines, visit the Links baby’s exposure.

Some parents who quit tobacco when they became pregnant may find it hard to stay
tobacco-free after their baby is born. It may be even harder if your partner, family or
friends use tobacco or if you’ve used tobacco as a way to cope with stress in the past. It’s
just as important to be tobacco-free after your baby is born. Quitting tobacco or staying
tobacco-free can reduce your child’s risk of
respiratory illnesses such as chest colds, asthma, It’s the law
ear infections, and SIDS.
As of November 2014, the
Being exposed to second- or third-hand smoke or Tobacco and Smoking Reduction
Act states that it’s illegal to
vapour can affect you and your baby’s health and
smoke in a vehicle when anyone
the health of those around you. The best thing under 18 years of age is in it.
you can do is cut down and quit.
If you choose to smoke or vape, it’s better to do it outside your home and away from
open windows and doors. Ask your family and friends to do the same. Make your vehicle
smoke- and vapour-free.
Third-hand smoke is the smoke that stays on your clothes

and body. If you smoke or vape or have been exposed to
second-hand smoke, make a habit of washing your face
and hands, and changing your clothes before holding or
cuddling your baby. Place your clothing outside on a porch
or balcony, until they can be washed, so you do not bring
the toxic chemicals back into your home.
Since breastmilk has so many benefits, it’s recommended

you still breastfeed even if you’re using tobacco. For more
information, see page 304.
To access resources to help you quit or stay tobacco-free, at no cost to you, call
the AlbertaQuits helpline toll-free at 1-866-710-QUIT (7848) to talk with trained
counsellors. To learn more about becoming tobacco-free, visit albertaquits.ca
If you smoke or vape, the best thing you can do for you and your
family is to cut down and quit. If you chose to smoke or vape, it’s
better to do it outside of your home and away from your family.

Cannabis
Using cannabis can affect how you think and make decisions. This can impact your ability
to care for your baby and other children, creating an unsafe environment. Using cannabis
while breastfeeding is also not advised as it could affect a baby’s developing brain
(see page 305).
Breathing in second-hand smoke from cannabis can cause babies and young children to
be sick and can affect their level of alertness, understanding and judgment. If someone
around you uses cannabis, do not let them smoke or vape in your home, vehicle or any
closed spaces around your baby and other children.
If you use cannabis, talk with your health care provider about cutting down and quitting.
For more information, see page 73.
Other drugs
Using other drugs such as ecstasy,
methamphetamines, cocaine, Break free of addiction
heroin and fentanyl can affect how If you use other drugs, the best thing you
you think and make decisions. This can do for yourself, your partner and your
can create an unsafe environment children is to cut down and quit. To learn
for you and your baby. When you more, call the confidential Addiction Services
Helpline 24/7 toll-free at 1-866-332-2322.
use these drugs you may not be
able to properly supervise and care
for your baby.
Talk with your health care provider if you’re using drugs or having trouble quitting. They
can suggest safe ways to cut back and quit that are right for you. For more information
about other drugs, see page 74.

Healthy Relationships
It’s common to feel a bit
overwhelmed with your baby’s needs
and your new responsibilities. Having
a baby is a very big life event for the
whole family. Whether you have a
partner or are a single parent, think
and talk about your relationship with
your main support person.
Families go through many changes

when a baby arrives. The amount
of time it takes to get used to these
changes is different for every family
and may be a lot different from what
you expected.
The most common causes of stress in relationships are miscommunications and

expectations that are not met. Talk with your partner or support person about some of the
new challenges you’re going through now that your baby is here, and about how you can
cope together.
As a new parent, your emotions may go up and down. You may feel excited one day and
overwhelmed with responsibility the next. A new baby often changes everyone’s sleep
patterns. While everyone needs to get enough rest, it may seem like nobody is getting
enough. You and your partner may have less time to talk and spend time together. This
can be hard on your relationship. You might disagree more often or find that things just
do not feel like they used to. You may also feel that you do not have the energy to sort out
problems when they come up. These challenges can lead to arguments or tension. Try to
keep communication open and honest. The best way to take care of your baby is for you
to take care of yourselves. Make some time for yourselves, take a break together and share
the responsibilities of looking after your baby. Ask for help when you need it.
If you’re interested in finding a parenting or relationship class, group support, or

one-to-one support:
■■ talk with your health care provider
■■ call Health Link at 811

Parents may have different parenting styles right from the start. The most important
thing is that you get to know your baby and give them safe and nurturing care.
Here are some ideas to help you adjust to your new role as a parent:
■■ Talk with your partner about how you’re ■■ If you have not already, take an active
both going to handle new challenges in role in your baby’s care, like doing
your lives. skin-to-skin, bathing, talking, reading or
■■ Talk honestly about your feelings and singing to your baby.
how you feel you’re adjusting to your ■■ Look over your family budget and talk
new role. about any changes that need to be
■■ Talk to friends or co-workers who have made.
children. You may be surprised how ■■ Have a checkup with your health care
much you now have in common. provider.
If you have older children

Having a new baby in the family is a big life change for your older children too. Children
can have many different reactions to a new baby. They may have little interest in their
new sibling or they may be very excited. Sometimes they may not like the new baby, and
feel jealous or angry. They may even return to baby-like behaviours for a short time. Be
patient—this is common and will pass. Do not punish or shame your older child for this
behaviour. It does not help and can harm their attachment with you as well as their sense
of self and belonging.
Here are some ideas to help your older children adjust and feel more secure:
■■ Before your new baby arrives, tell your ■■ When welcoming visitors, say what a
older children the story of their own birth. great help your older children have been.
Look at photos of them as babies and talk Ask visitors to interact with your older
with them about what they could do as child or children first, then your new baby.
a baby. ■■ Tell them it’s okay to talk about their
■■ Read books with them about pregnancy, feelings.
birth or adoption and new babies. ■■ Hold off on toilet teaching, starting child
■■ With or without your partner, try to spend care or moving to a new bed for several
time alone with your older children weeks after your new baby comes home.
every day.

Try to name your older children’s
■■
emotions with them. “Are you feeling

sad because mommy doesn’t have as
much time to spend with you? It’s okay
to feel sad. What can we do to help you
feel better?”
■■ Get them involved with caring for
your baby, like help with getting
a diaper.
■■ Encourage and teach your older
children how to gently hold, touch
or play with your baby in a safe way.
Make sure you always supervise
them.
■■ Try to keep routines the same as they
were before your baby arrived, such
as keeping the same bedtime and
any usual scheduled activities.
Advice from others

Everybody has advice about babies. Some people build up your confidence when they
give you advice and others may seem less supportive.
■■ Ask for advice from people you trust. Think about their suggestions—will they work for
your family?
■■ Nobody knows it all—including the person who’s giving you advice.
■■ You know your baby best. Trust your own judgment.
■■ If you have questions, call Health Link at 811 or talk with your health care provider.
Build your skills by going to parenting classes and reading health resources like the book
Healthy Parents, Healthy Children: The Early Years or visit healthyparentshealthychildren.ca

Healthy sexuality
Physical and emotional changes after your baby is born can affect both partners’ sexual
desire. Some couples are not interested in sexual activity for the first few months, some
couples are, and sometimes it varies between partners.
You can start sexual activity again when your vaginal bleeding has stopped and you feel
ready. Common changes that can affect your sexuality in the weeks or months after you’ve
had your baby are:
■■ vaginal bleeding and
discharge
■■ vaginal dryness due to
hormone changes. This
may make intercourse
uncomfortable
■■ having a sore perineum, for a
few weeks
■■ having a sore caesarean birth
incision for the first few weeks
■■ feeling tired and not wanting
to be touched
■■ nipples and breasts that may be Birth control
tender during the first few weeks Make sure you talk to your health care
provider about birth control options
■■ changes in body image
before you have sexual intercourse again.
If you’re breastfeeding:
■■ Your breasts may leak milk when you’re sexually excited or during an orgasm.
■■ You may feel a sense of sexual arousal while breastfeeding. This is normal—the same
hormones that help release breastmilk cause this feeling.
■■ Feeding your baby may often leave you feeling like you do not want to be touched by
your partner.
Be gentle and patient with each other. Be sure you’re both physically comfortable and
emotionally ready. Sexuality and intimacy can be expressed in many ways. Intimacy can
include cuddling, hugging, kissing and showing tenderness towards each other. Talk about
your feelings and try to understand each other’s needs.

Birth control
You can get pregnant again before your menstrual period returns and while breastfeeding.
This is because you’ll release an egg (ovulate) before your first period starts. Breastfeeding
only works as a birth control method if you follow the lactation amenorrhea method (LAM)
exactly (see page 268).
Talk with your health care provider before re-starting the birth control method you were
using before you became pregnant. Some methods of birth control such as the patch,
combined hormone birth control pills, and rings can’t be used if you’re breastfeeding
because they can decrease your milk supply. Your health care provider can help you find a
birth control method that works with breastfeeding. If you were using a diaphragm, it will
have to be fitted again because of changes to your cervix after a vaginal delivery.
Planning to become pregnant again—or not—is a big decision. Your body needs
time to recover from pregnancy and birth before you get pregnant again. Taking time
to plan will help you be more ready, physically and emotionally. To learn more about
planning or not planning another pregnancy, talk with your health care provider or visit
readyornotalberta.ca
Birth control options

There are many types of birth control. Barrier methods block the path between the egg
and the sperm. If the egg and the sperm can’t meet, you can’t get pregnant. Barrier
methods include condoms, diaphragms and spermicides.
Other kinds of birth control contain hormones that prevent your body from releasing an
egg each month. If your body does not release an egg, you can’t get pregnant. Examples
of this type of birth control are the birth control pill, the patch, the ring and the injection.
Using a condom and another form of birth control—such as hormonal birth control and
condoms—gives the best protection against pregnancy and STIs.
If no method of birth control is used, 85% of women having unprotected sexual

intercourse will get pregnant within one year. Without using condoms, there’s also no
protection against STIs (see page 56).
To use an interactive tool about birth control, visit the Tools section at

Birth control pill
Description
■■ Contains the hormones estrogen and progestin. These act like your natural hormones.
■■ Stops your ovaries from releasing an egg. You can’t get pregnant if you do not release an egg.
■■ Your period may be more regular, lighter or ■■ Works 91% of the time with typical use.
shorter with less cramping. ■■ Do not use until 6 weeks after birth.
■■ May lower the chance of developing ovarian ■■ You must take the pill as directed.
and endometrial cancers.
■■ Take the pill at about the same time each day.
■■ May help with acne and painful periods.
■■ If you have high blood pressure, you should
■■ It’s safe to use for many years. not take the pill.
■■ You can get pregnant as soon as you stop ■■ There is a small risk of blood clots. The risk of
using the pill. blood clots increases if you’re over the age of
35 and smoke.
■■ It’s not recommended while you’re
breastfeeding, as it may decrease your
milk supply and expose your baby to extra
hormones.
■■ Does not protect against STIs or HIV.
Pill-progestin only ‘mini pill’

Description
■■ The progestin only ‘mini pill’ prevents pregnancy by decreasing and thickening the cervical
mucous which slows the movement of sperm, making it harder for them to get to the uterus. It
may or may not stop the release of an egg.
■■ Can be used while breastfeeding. It’s ■■ Works 92% of the time with typical use.
recommended that you wait until at least ■■ The progestin-only pill contains hormones in
6 weeks after the birth of your baby before all 28 pills in the package.
you start using it.
■■ Take the pill at about the same time
■■ Can be used by those who need an estrogen- every day.
free method of birth control.

Patch (EVRA®)
Description
■■ The patch looks like a thin, light brown bandage and is worn on the skin. You need a prescription
from your health care provider.
■■ The sticky side contains the hormones estrogen and progestin. These act like your natural
hormones.
■■ The hormones are absorbed through your skin and stop your ovaries from releasing an egg. You
can’t get pregnant if your body does not release an egg.
shorter with less cramping. ■■ Do not use until 6 weeks after birth.
■■ May lower the chance of developing ovarian ■■ You must remember to change your patch as
and endometrial cancers. directed.
■■ May help with acne and painful periods. ■■ If you have high blood pressure or migraines,
■■ It’s safe to use for many years. you should not use the patch.
■■ You can get pregnant as soon as you stop ■■ There might be a higher risk of getting
using it. pregnant if you weigh more than 90 kg
(198 lbs) or more.
■■ There is a small risk of blood clots. The risk of
blood clots increases if you’re over the age of
35 and smoke.
hormones.

Birth control injection (Depo-Provera®)
Description
■■ The birth control injection contains the hormone progestin. It’s injected into your arm or buttock
every 12–13 weeks by a health care provider.
■■ It stops your body from releasing an egg. You can’t get pregnant if your body does not release
an egg.
■■ It also decreases the amount of cervical mucous, making it thicker. This slows the movement of
sperm, making it harder for them to get to the uterus.
■■ Can be used while breastfeeding. It’s ■■ Works 94% of the time with typical use.
recommended that you wait until at least 6 ■■ You can have spotting or bleeding
weeks after the birth of your baby before you between your menstrual periods for
start using it. 3–6 months after your first injection. Your
■■ Long-acting, reversible method of birth control. menstrual periods might stop after 1 year.
■■ One injection lasts 12 weeks This is common and does not cause
health problems.
■■ Your period might stop.
■■ If you stop taking Depo-Provera® it
■■ May lower the chance of developing ovarian and may take up to 1 year for your regular
endometrial cancers. menstrual periods to return.
■■ May decrease menstrual period cramps. ■■ You may have a delayed return to fertility
■■ May decrease symptoms of endometriosis, for up to 2 years once you stop taking
premenstrual syndrome and chronic pelvic pain. Depo-Provera®.
■■ May increase your risk of thinning bones
(osteoporosis). Talk to your health care
provider if you have questions.
endometriosis: the development of uterine-lining tissue outside of the uterus that may cause abdominal pain, heavy
periods and infertility
premenstrual syndrome: physical and emotional symptoms that happen a few days or weeks before a menstrual
period starts

Vaginal contraceptive ring (NuvaRing®)
Description
■■ The vaginal contraceptive ring is a soft, flexible, clear plastic ring that you put in your vagina once
a month. You need a prescription from your health care provider.
■■ The ring contains the hormones, estrogen and progestin, which act like your natural hormones.
They stop your ovaries from releasing an egg. You can’t get pregnant if you do not release an egg.
shorter with less cramping. ■■ Do not use until 6 weeks after giving birth.
■■ May lower the chance of developing ovarian ■■ You need to remove the ring after 21 days,
and endometrial cancers. and reinsert a new one on day 28.
■■ May help with acne and painful periods. ■■ You need to check that the ring is in the right
■■ It’s safe to use for many years. place.
■■ You can get pregnant as soon as you stop ■■ If you have high blood pressure, you should
using the pill. not use the ring.
■■ You can put in and take out the ring yourself. ■■ There is a small risk of blood clots. The risk of
blood clots increases if you’re over the age of
35 and smoke.
hormones.

Intrauterine contraceptives
Description
■■ Intrauterine contraceptives (IUC) are small, soft pieces of T-shaped plastic with a nylon string
attached to it. They are put in your uterus by a health care provider.
■■ They prevent the egg and sperm from meeting. You can’t get pregnant if the egg and sperm do
not meet.
■■ There are 2 types of IUCs Copper and Hormonal. They work in different ways to help prevent
pregnancy.
■■ The copper intrauterine device (IUD) has a thin copper wire wrapped around it. It thickens the
mucous in the cervix and slows the sperm movement so it’s harder for the sperm to get to
the egg.
■■ Hormonal intrauterine systems (IUS), Mirena®, Kyleena® and Jaydess®, release a small amount of
hormone (levonorgestrel) into the uterus. The IUS thickens the mucous in the cervix and slows
the sperm movement so it’s harder for the sperm to get to the egg. It also changes the lining of
the uterus to stop a fertilized egg from growing inside the uterus and may stop the ovaries from
releasing an egg.
■■ Can be used while breastfeeding. ■■ Copper IUD: Works 99% of the time.
■■ Can be inserted early postpartum, before ■■ Hormonal IUS: Works 99.8% of the time.
48 hours, or later postpartum, after ■■ Does not protect against STIs or HIV.
4–6 weeks.
■■ The IUC can stay in for 3–10 years depending
on the type.
■■ The copper IUD may lower your risk of cancer
of the uterus.
■■ The hormonal IUS may make your periods
lighter, or you might even stop having
periods. It may also make your period
cramps better.
■■ If you want to get pregnant, your health care
provider can take out your IUC.

Condom-male
Description
■■ A condom is a disposable, thin covering that fits over a hard (erect) penis.
■■ It must be put on before intercourse and taken off and thrown away afterwards.
■■ It decreases the risk of pregnancy, STIs and HIV by stopping sperm and body fluids from passing
between partners.
■■ Can be used while breastfeeding. ■■ Works 82% of the time with typical use.
■■ Latex, polyurethane and polyisoprene ■■ Never reuse a condom.
condoms help protect against STIs and HIV. ■■ If you want more lubrication, use water or
■■ Can be used safely at any time after the birth silicone-based lubricant (read the product
of your baby. label).
■■ Do not contain hormones. ■■ There are polyurethane condoms for people
■■ Low cost form of birth control that are easy with latex allergies.
to find. ■■ Do not use oil products such as body lotion
■■ Are small and easy to keep with you. or petroleum jelly with a latex condom—it
will break.
■■ Store condoms at room temperature and out
of direct sunlight.
■■ Lambskin condoms do not protect against
STIs or HIV.
■■ Never use 2 male condoms together or
a male and vaginal condom together. It
increases the risk of both condoms breaking.

Condom-vaginal
Description
■■ A vaginal condom is a soft, plastic (non-latex) tube-like sleeve with two flexible rings, one on each
end. It’s sometimes called a female or internal condom.
■■ The closed inner ring goes inside your vagina, the outer ring stays outside your vagina to cover
your genitals.
■■ It must be put in your vagina before intercourse and taken off and thrown away afterwards.
■■ It decreases the risk of pregnancy, STIs and HIV by stopping sperm and body fluids from passing
between partners.
■■ Gives good protection against STIs and HIV. ■■ Use a new condom every time you have sex.
■■ Can be bought at a drug store without a ■■ Never reuse a condom.
prescription. ■■ More expensive than the male condom.
■■ Can be used by people with latex allergies. ■■ Store condoms at room temperature and out
■■ Does not contain hormones. of direct sunlight.
■■ Never use a male and vaginal condom
together. It increases the risk of both
condoms breaking.

Diaphragm
Description
■■ A diaphragm is made of latex, silicone or silicone/nylon, is disc-shaped, and has a flexible rim.
■■ You put it in your vagina to cover the opening of your uterus (cervix). It stops sperm from entering
your uterus.
■■ There are two types of diaphragms. A fitted diaphragm is available by prescription form a health
care provider. A one size diaphragm is available without a prescription at some pharmacies.
■■ A diaphragm should be used with an acid buffering gel (ContraGel®, Caya® Gel) which forms a
barrier in front of your cervix, lowers pH of vaginal fluid which slows down sperm.
■■ It must be inserted before intercourse and taken out and cleaned afterwards.
■■ Can be used while breastfeeding. ■■ Diaphragms are not widely available in

■■ Can be reused. Canada.
■■ Does not have hormones.
■■ Must be kept in place at least 6 hours after
intercourse.
■■ Can be left in place for up to 24 hours.
■■ There is no information on how well a
diaphragm works with acid buffering gel to
prevent pregnancy. There may be a higher
risk of pregnancy if you choose this method.
■■ To stop infection, do not use until your
vaginal bleeding has ended.
■■ You need to be re-fitted for a new diaphragm
after you’ve had a baby or if you gain or lose
more than 10 lbs.
■■ May increase your risk of a bladder infection.

Vaginal spermicides
Description
■■ Vaginal spermicides contain nonoxynol-9, a chemical that kills sperm (spermicide). They are put in
your vagina before intercourse each time to help prevent pregnancy. They come as film or foam.
■■ When sperm comes in contact with a spermicide, the sperm dies and you can’t get pregnant.
■■ Can be bought at a drugstore without a ■■ Protects against pregnancy better if used
prescription. with another birth control method, like a
■■ Does not have hormones. condom.
■■ Do not use in the first 6 weeks after birth.
■■ Film must be inserted into your vagina at
least 15 min before intercourse.
■■ Foam must be inserted into your vagina using
an applicator and works right away.
■■ May cause some vaginal irritation. This can
increase your risk of getting an STI or HIV.

Sponge
Description
■■ The sponge (Today® Sponge) is a disposable piece of soft foam that is put in your vagina to cover
the opening to your uterus.
■■ It’s filled with nonoxynol-9, a chemical that kills sperm (spermicide).
■■ It helps prevent pregnancy by killing sperm and preventing sperm from entering your uterus.
■■ Can be used while breastfeeding. ■■ Works 76% of the time with typical use if
■■ Can buy at a drugstore without a prescription. you’ve had a baby.
■■ You can put the sponge in several hours
■■ Works 88% of the time with typical use if you
before you have intercourse. have not had a baby.
■■ Does not have hormones.
■■ Protects against pregnancy better if used
with another birth control method, like a
■■ Protects for up to 24 hours. condom.
■■ Do not use in the first 6 weeks after birth.
■■ To stop infection, do not use until postpartum
bleeding has ended.
■■ It needs to be left in place for 6 hours after
use.
■■ May cause some vaginal irritation. This can
increase your risk of getting an STI or HIV.

Lactation amenorrhea method (LAM)
Description
■■ ‘Lactation’ means your body is making breastmilk and ‘amenorrhea’ means you’re not having a
monthly period.
■■ Lactation amenorrhea method (LAM) is a way for breastfeeding to temporarily help prevent
pregnancy. It must be used correctly to work.
■■ Exclusively breastfeeding helps prevent an egg being released from your ovary each month. You
can’t get pregnant if your body does not release an egg.
■■ Works for up to 6 months after birth, if you’re ■■ Works 98% of the time in the first 6 months
exclusively breastfeeding. after birth, if used correctly.
■■ There is no cost and no birth control supplies ■■ Works only if your:
are needed period hasn’t returned—this means no
■■ It’s effective right away. spotting or bleeding for 2 months after
■■ There are no added hormones that can affect you’ve had your baby and
your breastmilk. your baby does not go more than 4 hours
between breastfeedings during the day or
6 hours at night and
your baby is under 6 months old and
your baby is exclusively breastfed—no
other liquids or solid foods except
vitamins, vaccines and medicine are given
■■ You need to start another method of birth
control if you do not have all 4 things above.
■■ LAM does not work if you have had a period
(spotting or bleeding).

Natural family planning/fertility awareness-based (FAB)
Description
■■ Natural family planning/fertility awareness-based (FAB) methods help you understand how to
prevent a pregnancy by not having sex during your fertile time.
■■ There are many different methods (Standard Days Method®, Calendar Rhythm Method, Cervical
Mucous, Basal Body Temperature, TwoDay Method®, Symptothermal Method).
■■ With the FAB method, you:
identify the most likely time to get pregnant (fertile time)
must not have sex (abstain) or must use another method of birth control during your
fertile time
need one-to-one training to know how to use the method the right way
Advantages Things to think about
■■ You do not need any birth control supplies. ■■ How well FAB methods work is hard to
estimate. With typical use (not following
exact directions), the pregnancy rate is about
24% after 1 year.
■■ Less reliable after birth and while
breastfeeding.
■■ Need to speak with a health care provider or
group that can explain natural methods.
■■ It takes several months to become familiar
with your fertility cycle.
Withdrawal
Description
■■ Withdrawal is when the penis is pulled out of the vagina just before cum (ejaculation).
■■ To prevent pregnancy, a person must not ejaculate near your genitals. Pregnancy can occur if the
cum is near the opening of the vagina and sperm gets in.
■■ Withdrawal is better than using no birth ■■ Works about 78% of the time with typical use.
control at all. ■■ Some men have trouble knowing when
■■ It’s available in any situation. they’re about to ejaculate and so may not pull
■■ You do not need any birth control supplies. out in time.

Tubal ligation
Description
■■ Tubal ligation is a permanent form of birth control for females.

■■ Surgery is done to close the tubes the egg travels through (fallopian tubes). This stops the egg
and sperm from meeting. If the egg and sperm can’t meet, you can’t get pregnant.
■■ Works right away. ■■ Works 99.5% of the time.

■■ Does not interrupt sex. ■■ All surgery has some risk, such as bleeding,
■■ Does not affect your hormone levels or your infection or the effects of anesthesia.
sex drive. ■■ Can be done if you’re having a caesarean
■■ Can be done as day surgery in a hospital. birth. If you’re interested in a tubal ligation,
talk with your health care provider during
■■ Covered by Alberta Health Care. your pregnancy.
■■ You do not need any birth control supplies. ■■ Can sometimes be reversed. The reversal can
be expensive and is not covered by Alberta
Health Care.
Vasectomy
Description
■■ A vasectomy is a permanent method of birth control for males.

■■ Surgery is done to close the tubes (vas deferens) that carry sperm. Without sperm, an egg can’t be
fertilized and a female can’t get pregnant.
■■ Does not affect sex drive or sexual ■■ Works 99% of the time.
performance. ■■ Does not work right away. All sperm will be
■■ The surgery takes 15–30 minutes. cleared after a few ejaculations. Be sure to
■■ Can be done as an outpatient procedure at have a sperm test done with your health care
some clinics. provider.
■■ Covered by Alberta Health Care. Some fees
■■ All surgery has some risk, such as bleeding or
may apply. infection.
■■ A vasectomy is a safer procedure than a tubal
ligation.
■■ Can sometimes be reversed. The reversal can
be expensive and is not covered by Alberta
Health Care.

Emergency contraception
Description
■■ Emergency contraception (EC) helps prevent pregnancy after you’ve had unprotected sex or your
birth control method fails, such as a condom breaking.
■■ There are 2 forms of emergency contraception:
EC pill: hormone pills that delay the release of an egg.
Copper IUD: a small, soft, T-shaped device with a copper wire wrapped around it. The IUD is
inserted into your uterus by a health care provider. It stops the egg and sperm from meeting
and may prevent a fertilized egg from attaching to your uterus.
■■ Can use EC pills up to 5 days (120 hours) after ■■ EC does not protect against STIs or HIV.
unprotected sex.
Copper IUD:
Levonorgestrel EC pills—you do not need ■■ Most effective form of EC.
a prescription. You can buy them at most
drug stores. ■■ Need a prescription.
Ulipristal acetate EC pills—you need a ■■ Needs to be put in by a health care provider.
prescription. ■■ Long-acting, reversible method of birth
■■ Can use the copper IUD up to 7 days after control.
unprotected sex. Levonorgestrel EC pills:
■■ Can use the copper IUD and levonorgestrel ■■ Works best if used as soon as possible after
EC pills while breastfeeding. unprotected sex.

Ulipristal acetate EC pills:
■■ More effective than levonorgestrel.
■■ Need a prescription.
■■ Not recommended while breastfeeding.
■■ Doesn’t give continued protection against
pregnancy. Think about starting a reliable
method of birth control.

Abstinence
Description
■■ Abstinence means making the decision not to directly touch your partner’s genitals or have
vaginal, anal or oral sex.
■■ As a method of birth control, abstinence is the decision to not have any sexual activity where the
egg and sperm could meet and create a pregnancy.
■■ Protects against STIs and HIV. ■■ Works 100% of the time.

■■ You do not need any birth control supplies. ■■ This may not be a realistic option if you are in
a relationship
■■ Talk with your partner about your choice to
be abstinent and what sexual activity is okay
with you.
■■ Sometimes it might be hard to stay abstinent.
Think about having a back-up method, like
condoms, with you in case this happens.

Breastfeeding

273
Breastfeeding
If you’re looking for information about breastfeeding, this chapter’s for you!
Breastfeeding gives your baby the nutrition they need to grow and develop.
It’s the only food babies need until they’re about 6 months old, when they’re
ready to start eating solid foods.
274
Breastfeeding Your Baby
BREASTFEEDING
Breastfeeding provides food, security and comfort for your baby. Your health care
providers are there to help you with your breastfeeding goals, whatever they are.
You can breastfeed whether you’ve had a

vaginal or caesarean birth and no matter Breastfeeding goals
what size your breasts are. If you’ve had breast Think about your breastfeeding
surgery, have concerns about your breasts or goals and what support you need
have a medical condition, talk with your health to meet them.
care provider.
Exclusive breastfeeding for the first 6 months of life

and continued breastfeeding up to 2 years of age
and beyond is recommended. At about 6 months,
you can start giving your baby solid foods.
Learning to breastfeed takes time and practice. You

may find breastfeeding easy or you may find that
sometimes it’s not as easy as it looks, especially
in the first few weeks. Take one day at a time. It
can sometimes take 4–6 weeks for you to feel
comfortable and confident with breastfeeding.
Getting encouragement and support from your

partner, family, friends and health care providers
can help you feel more confident and make
breastfeeding easier. You can also get support by talking with other women who are
breastfeeding or by joining a breastfeeding support group. Ask for help early and as often
as you need it. To find out about programs in your area call Health Link at 811 or talk with
Vitamin D for all babies

“ Breastfeeding might take
”
Vitamin D helps your baby’s body longer than you expect it to
absorb calcium and develop healthy in the early days.
bones. It also prevents rickets.
All babies need 400 IU of a liquid ~ Ayesha, mom of a toddler
vitamin D supplement every day.

Breastfeeding benefits
Breastfeeding is healthy for you and your baby. Breastmilk has all the nutrition and fluid
your baby needs in their first 6 months, other than vitamin D. Give your baby a liquid
vitamin D supplement of 400 IU every day.
Breastfeeding has many benefits for you

and your baby. For your baby, breastmilk: Breastfeed anytime, anywhere
You can breastfeed wherever you want.
■■ is self-adjusting and changes to meet
It’s legal to breastfeed in public. Many
their needs, even during growth spurts
shopping malls have parent rooms for
■■ is easy to digest breastfeeding and changing babies if
you’re looking for comfortable chairs
■■ gives them antibodies that may reduce
and more privacy.
the risk of some types of illnesses,
If you want, you can also put a scarf or
infections and diseases
blanket over your shoulder for privacy,
■■ may reduce the risk of SIDS or if your baby gets distracted.
For you, breastfeeding:

■■ helps your uterus contract to its pre-pregnancy size
■■ may lower your risk of breast and ovarian cancer—the longer you breastfeed, the lower
your risk
■■ may help you lose some of the weight you gained during pregnancy
■■ may stop menstrual periods during the first 6 months, and sometimes even longer, if
you’re exclusively breastfeeding
■■ helps you feel close to your baby
There are also other benefits of

breastfeeding. These include:
■■ having readily available food for your
baby that is always the right temperature
and concentration
■■ being an environmentally friendly
feeding method—you do not need
containers or packages
■■ possibly saving you money because
you do not need to buy infant formula,
bottles or artificial nipples
growth spurt: a time when your baby is growing faster than usual and they may suddenly want to feed more often
or longer

How breasts make milk
BREASTFEEDING
Breasts are made up of clusters of milk-producing
cells (milk glands) connected by a network of ducts.
Milk glands This network is close to the nipples, which have
Ducts
many tiny openings. Milk flows from the milk glands
Nipple
through the ducts and nipple openings.
Areola
When your breasts release milk it’s called a let-down

or milk ejection reflex. Muscles around the milk-
producing cells contract to push milk into your
ducts and out through your nipple.
You may feel tingling or pressure in your breasts as your milk is released. Not everyone feels
this. You may also have a let-down when you hear your baby cry. When this happens, milk
may leak from your breasts.
Your milk will change to meet your baby’s needs. The milk you make in the first few days
after your baby’s born is called colostrum. You’ll make very small amounts of this high
calorie, thick, yellow milk. Because colostrum has antibodies, it gives your baby protection
against infections and diseases. Along with having important nutrients, colostrum also acts
as a natural laxative to help your baby pass meconium. Colostrum is the only food your
baby needs in the first few days.
Your milk will gradually change from colostrum to transitional milk to mature milk over the
first 2 weeks after your baby’s born. You’ll notice your breasts becoming fuller and heavier.
They may also feel more tender. The colour of your milk will change from clear or yellowish
(colostrum), to bluish-white or white (mature milk).
Babies feed often

Breastmilk supply Your baby will feed often because:
Feeding your baby often and for as long as ■■ breastmilk is digested quickly
they want to feed, day and night, will help you
■■ at birth, your baby’s stomach is
establish your milk supply and meet your baby’s
small—it can only hold around
needs. Your baby’s stomach is small and they 20 ml (4 tsp)
can only drink small amounts at a time at first.
Your baby’s sucking tells your body to make as much milk as your baby needs. The amount
your baby drinks changes at each feed, sometimes they’ll want a ‘full meal’ and other times
just a ‘snack’. The more your baby feeds at the breast, the more milk your body makes.
meconium: greenish-black sticky stool passed usually within the first 48 hours after birth

Nighttime feeds may seem challenging, however, these feeds play an important role in
keeping your milk supply up.
Your breasts will feel full between 2–6 days after Twins, triplets and more
your baby’s birth. After this time it’s normal for Many moms are able to breastfeed
your breasts to start to feel softer. For the first more than one baby at a time. Talk
6 weeks, you’ll notice your breasts feel full before to your health care provider if you
feeds, become softer after feeds and begin to have any questions.
fill again between feeds. This is a good sign that
your body is making milk to meet your baby’s needs. Full breasts produce milk slower and
drained breasts make milk faster. Feeding your baby as often as needed and not delaying
or timing feeds will help to keep your breasts soft and comfortable. It will also make sure
that your baby gets the amount of milk they need. This helps your baby develop healthy
eating patterns and supports growth and development.
You may also find that your baby suddenly

wants to feed more often, feed longer or
cries more. Babies who need to feed more
often may be having a growth spurt. This
usually happens when they’re around
2–3 weeks, 6 weeks and 3–4 months old.
Growth spurts only last a few days. As your
baby breastfeeds, you’ll make the amount of
milk that matches what your baby needs.
It’s common to wonder if you’re making

enough milk in the first few weeks. For more
information on how often and how long to
feed your baby, see page 286. Your health
care provider will also help you to understand
the signs that your baby is receiving the
amount of breastmilk that they need.
What about herbal products?

Some herbal products such as teas may claim to increase your milk supply. They can act
like medicine and may not be safe for you and your baby. To find out more about herbal
products and if they’re safe, talk with your health care provider or call the Medication &
Herbal Advice Line toll-free at 1-800-332-1414. To learn more, visit the Links section at

If your baby is not able to breastfeed or is not breastfeeding well, make sure you ask for
BREASTFEEDING
help. Your baby feeding at the breast is the best way to increase your milk supply and to
remove milk from your breasts. If your baby
is not able to do this, you can establish and
maintain your milk supply by removing
the milk from your breasts often, either by
expressing by hand or with a breast pump.
You can feed your baby your expressed

breastmilk (see page 293). If you supplement
with infant formula and do not express or
pump your own milk, your breastmilk supply
will decrease. © Belle Verdiglione Photography
www.perthbirthphotographer.com.au
Breastfeeding Basics
With time and practice, you and your baby will
Skin-to-skin
become more comfortable with breastfeeding. Early
skin-to-skin cuddling with your baby is important Cuddling skin-to-skin with your
baby is a great way to help you
for getting breastfeeding started and will help you
get started with breastfeeding.
learn to read your baby’s feeding cues.
Your health care provider will encourage you to breastfeed your baby soon after they’re
born. They will help you with positioning and latch. Some babies want to breastfeed right
away and others may just want to cuddle. Most babies will have their first feed within the
first hour after they’re born.
Health care providers like public health nurses have information and skills to help you
learn about:
“
■■ your baby’s feeding cues
Have supportive people around
breastfeeding positions
you who know what your plan is for
■■
”
■■ correct latch breastfeeding and who are able to
■■ how to tell if your baby is getting help set you up for success.
enough breastmilk
~ Jasminder, mom of a toddler
■■ what you can do if you have
breastfeeding challenges

A baby needs a lot of attention during the
first months of life and they’ll spend a lot of
time breastfeeding. You can help support
your breastfeeding partner by:
■■ giving her time to learn to breastfeed
■■ giving her time to cuddle together
skin-to-skin
■■ having her rest when your baby sleeps
■■ bringing your baby to her for
breastfeeding
■■ preparing healthy foods and going
■■ asking if you can help her with
grocery shopping
positioning your baby at the breast
■■ finding her support if needed
■■ doing diaper changes, burping and
bathing your baby ■■ staying awake while she is feeding
your baby, especially if your partner
■■ doing extra household tasks
is tired or laying down, and help
■■ limiting visitors and phone calls them by returning your baby to
■■ bringing her water to drink their crib or cradle when she’s done
feeding your baby
Feeding relationship and cues

Your baby is born with the ability to regulate and eat the amount of food they need. In the
beginning, your role as a parent is to decide what your baby eats and to follow their cues.
Your baby’s role is to let you know when they’re hungry and when they’re full. By having
a healthy feeding relationship right from the start, you’ll help your baby develop healthy
eating habits for life.
The early months with your new baby are a time of learning for all of you. When you
respond to your baby’s cues you’re helping to build a secure attachment and a trusting
relationship. You’re also teaching your baby to listen to their body and to stop eating
when they’re full. Watch your baby for early hunger cues—babies feed best when they’re
quiet and alert. If you’re having trouble reading your baby’s cues, talk with your health
care provider.

Baby Feeding Cues (signs)
BREASTFEEDING
Early cues “I’m hungry.”
Stirring Mouth opening Turning head, seeking/rooting
Mid cues “I’m really hungry.”
Stretching Increasing physical movement Hand to mouth
Late cues “Calm me then feed me.”
Crying Agitated movement Colour turing red
Time to calm crying baby

■■ cuddling
■■ skin-to-skin on chest
■■ talking
■■ stroking
CPN / 840
For more
Partneringinformation referStandard
with Consumers National to the2 (2.4)
Queensland Health booklet Child
To view Health
the terms of thisInformation: Your guide to the first twelve months
licence, visit: http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en
Consumers and/or carers provided feedback on this publication. For permissions beyond the scope of this licence email the Intellectual Property Officer: ip_officer@health.qld.gov.au
Visit the Queensland Health breastfeeding website: http://www.health.qld.gov.au/breastfeeding/
Version 4.0 Effective: 05/2015 Review: 05/2018 © State of Queensland (Queensland Health) 2010
CPN / 840
Partnering with Consumers National Standard 2 (2.4) To view the terms of this licence, visit: http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en
Consumers and/or carers provided feedback on this publication. For permissions beyond the scope of this licence email the Intellectual Property Officer: ip_officer@health.qld.gov.au
Version 4.0 Effective: 05/2015 Review: 05/2018 © State of Queensland (Queensland Health) 2010

Babies need to eat during the day and night. Your baby feeds in their own way to meet
their needs. Your baby will let you know when they’re hungry with their feeding cues
(see page 281) and when they’ve had enough, they’ll show signs of fulllness. Signs of
fullness may include:
■■ slowing down or stopping their sucking ■■ letting go of or turning their head away
and swallowing from your nipple
■■ looking relaxed (e.g., extending their ■■ pushing or arching away
arms and legs, extending or relaxing ■■ falling asleep at the end of the feeding
their fingers)
For the first 6 months, your baby will likely wake up to feed during the night. Keep your
baby close when they sleep—in the same room as you (room sharing), but on a separate
sleep surface such as a crib, cradle or bassinet. This will make it easier to feed your baby,
especially at night. It also makes it easier to learn and respond to your baby’s cues. Once
your baby is done feeding and is ready to sleep, always place them on their back in their
crib, cradle or bassinet.
Positioning
You may need to try several positions before you find
one that works for both you and your baby. Whatever
position you breastfeed your baby in, make sure you
use good posture and:
■■ have the supports you need (e.g., cushions and
pillows) to sit, lie or stand in a comfortable position
■■ bring your baby to your breast—not your breast to
your baby
■■ keep your baby’s hands free—their hands help them find their way to your breast
■■ support your baby across their shoulders and behind their ears at the base of their head
with your arm and hand
‘C’ and ‘U’ hold

If you need to support your breast, you can use a ‘C’ hold or a ‘U’ hold, depending on the
position that you choose.
■■ For the ‘C’ hold, gently hold your breast with your fingers in line (parallel) with your
baby’s mouth.
■■ For the ‘U’ hold, place your fingers flat on your chest wall and hold your breast from
below with your fingers and thumb.

Place your hand on your breast without covering the areola. This way, your hand does not
BREASTFEEDING
interfere with your baby’s latch. Do not apply too much pressure on your breast as this
could cause a poor latch or blocked ducts.
‘C’ Hold ‘U’ Hold
Common positions
Cross-cradle position
1. Sit up as straight and tall as you can.
2. Support your baby at the level of your breasts.
3. Lay your baby on their side on a pillow. Their ear,
shoulder and hip should be in a straight line.
4. Use your hand that’s on the same side that your baby is feeding on to support your
breast. Make a ‘C’ shape with your hand to support your breast, if you need to.
5. Use your other hand to support your baby’s head at the base of their skull. Place your
arm along your baby’s back and bring them close to your breast.
Cradle position
1. Sit up as straight and tall as you can.
2. Support your baby at the level of your breasts
using the arm on the same side that your baby is
feeding on.
3. Cradle your baby close to you.
4. Keep your other arm free.
If you prefer the cradle position and are having trouble latching your baby, start with a
cross-cradle position. Then let go of your breast support (step 4 of cross-cradle) and move
your arm into the cradle position.
areola: the dark area around the nipple of the breast

Football or clutch position
1. Sit up as straight and as tall as you can.
2. Use a pillow at your side to support your baby at
the level of your breast.
3. Hold your baby with your nipple pointed toward
their nose. Your baby’s head will be slightly tilted
back, with them looking up at you.
4. Support your baby using the hand that’s on the
same side your baby is feeding on.
5. Use your hand to hold your baby’s head at the base of their skull, and use your arm to
hold them close to your body. When your baby opens their mouth wide, use your hand
to quickly bring them to your breast.
6. Make a ‘C’ shape with your opposite hand to support your breast, if you need to.
Side-lying position
1. Lie on your side with one pillow under your head and
another tucked behind your back. You may also like a
pillow between your knees.
2. Lie your baby beside you on the bed tummy-to-tummy,
with their nose touching your nipple.
3. Place the palm of your hand on your baby’s upper back.
When your baby opens their mouth wide, use your hand
to quickly bring them to your breast.
4. Use your hand on your baby’s back to keep them tucked
Reproduced with permission from
in close while breastfeeding. Gray, K. (2013).
Laid-back position
1. Lie back so that you’re semi-reclined in a chair or on a bed.
2. Use pillows to support your back and head, if you need to.
3. Lay your baby on you, tummy-to-tummy, and near your
nipple. This position helps to move your baby’s tongue
and chin forward.
4. Make sure your baby’s thighs and feet are touching a
surface that helps them ‘crawl’ towards your nipple
to latch.

BREASTFEEDING
Keep your baby safe during sleep
Taking your baby into bed for feeding or for comfort is risky if you fall asleep. If you
choose to sleep with your baby on the same sleep surface (bed share) or feel you may
fall asleep while feeding your baby, follow the recommendations about bed sharing
and how to do it as safely as possible to reduce some of the risks (see page 292).
Latch
A correct latch is important. It helps:
■■ your baby drink milk from your breast
■■ you make breastmilk
■■ you feel more comfortable during the feed
Here are the steps to follow for a correct latch.

1. Once you and your baby have found a comfortable
position, hold your baby’s head at the base of their skull,
below and behind their ears—the palm of your hand will
be between your baby’s shoulder blades. Try not to touch
your baby’s cheeks. Keep your baby’s hands free—their
hands help them find their way to your breast.
2. With your baby positioned at the level of your breast,
tuck their body tightly to you so their lower lip touches
the outer part of your areola. Your nipple should come in
just under their upper lip. This helps your baby smell your
breastmilk and get ready to feed.
3. Slightly tilt your baby’s head back so that their chin
touches your breast. Your baby’s lower jaw is now under
your breast which helps them take as much of your breast
into their mouth as possible. This is a deep latch. Your
baby’s mouth opens wide, like a yawn, and their tongue
cups and stretches out over their lower gum.
You can encourage your baby to open their mouth wide Top three photographs printed with
permission: © Crown copyright 2010.
by expressing a bit of your milk and slowly touching Produced by COI for the Department
your nipple against their lips. You may need to do this a of Health, Great Britain.
few times.

“
4. Use your hand to gently press on the
If you’re not sure if your baby is
back of their neck and shoulders and
latching correctly, ask a health care
pull them closer to your breast. Move
your baby onto your breast with their provider to watch you feeding your
chin touching first. baby. I found this helpful at the
”
beginning. I learned what changes
5. Your baby’s cheeks will look full and
round when feeding. At first their suck I needed to make early on.
and swallow will be fast, and then it will
~ Alexandra, mom of a baby
slow down.
Babies can easily breathe when breastfeeding, even with their nose close to your breast. If
your baby’s nose is too far into the breast and they cannot breathe, they’ll naturally come
off your breast. Re-adjust for the next latch by:
■■ pulling your baby’s bottom closer to you
■■ tipping their head back a little bit
■■ bringing their chin in more deeply
When your baby latches on correctly, you’ll feel a pulling sensation, not pain. If you have
pain in your nipples, bruising, blisters or cracks, get help as soon as possible.
If you have any questions, call Health Link at 811 or your health care provider.
The First Week and Beyond

The first week of your baby’s life is full of changes for all of you. In the early days, it may
seem like you’re feeding your baby all the time, as one feed blends into the next. Set up a
comfortable space and get ready to settle in. Keep a basket of healthy snacks and a water
bottle within arm’s reach. Also, keep a book, your phone or access to a TV show or movie
close by.
How often does my baby need to feed?

Babies should feed at least 5 times in the first 24 hours after they’re born. After that, they’ll
feed at least 8 times every 24 hours.
Your baby’s feeding cues will tell you when they are hungry and full. This information gives
you an idea of how much your baby takes in for the first few weeks:
■■ 2–10 ml (0.1–0.3 oz) at 24 hours old ■■ 30–60 ml (1–2 oz) by 3–5 days old
■■ 15–30 ml (0.5–1 oz) at 48–72 hours old ■■ 60–90 ml (2–3 oz) by 8–21 days old

You may find that your baby eats quite a bit more during growth spurts. They may also
BREASTFEEDING
cluster feed. This can happen anytime, but is most common during the evening.
As babies get older, they become better at sucking and will continue to get the amount of
milk they need to grow. Here’s what you may see during your baby’s first few days.
Baby’s age and behaviour How often they feed What you can do
Birth to 24 hours old
■■ may be awake, alert and quiet ■■ will feed at least 5 times in ■■ watch for their feeding
during the first few hours the first day (24 hours) cues
■■ may not want to feed right away, ■■ may have periods where ■■ do skin-to-skin cuddling
as they recover after birth they cluster feed 5–10 ■■ keep their hands free
■■ may have a long sleep, waking times over 3–5 hours then so they can touch your
up once in a while to feed or sleep for 4–5 hours breast
cluster feed ■■ massage your baby
gently to help them
wake up to feed
■■ if you do not notice
feeding cues or are not
sure, ask for help
24 to 48 hours old
■■ will wake and show feeding cues ■■ will actively feed at least 8 ■■ offer your breast
■■ feed as often as every times in a day (24 hours) whenever they want—
30 minutes to 3 hours ■■ may have 1–2 long periods follow their feeding cues
■■ by the 2 or 3 day, they’ll be
nd rd of cluster feeding ■■ listen for their quiet
more alert during feedings ■■ by the 2 or 3 day, they’ll
nd rd swallowing noises
■■ they’ll have a strong sucking feed at least 8 times in a
reflex, with their lower jaw day (24 hours), with no set
moving schedule
3 days to 1 month old
■■ will wake and show feeding cues ■■ will feed at least 8 times in ■■ breastfeed your baby
■■ you’ll be able to hear their a day (24 hours) whenever they want—
swallowing during feedings ■■ feedings may not be follow their feeding cues
■■ by 4 days old, their swallows are spaced evenly. Your baby
easier to hear and sound like may feed every 2–3 hours
‘ka, ka, ka’ mixed with 1 or 2 long
periods of cluster feedings.
cluster feed: frequent, small feeds within a short time

“ I had a breastfeeding chair I always sat in and my partner would have a little
snack pack there for me with apples and muffins and a bottle of water so that
”
when I got up to feed in the middle of the night they were already there. It’s the
little things that made life easier.
~ Chelsea, mom of a toddler
How long should I feed my baby?

There’s no set amount of time that your baby should feed. Let your baby feed as long and
as often as they want to. Your baby’s appetite may vary from day-to-day and from feeding
to feeding. Follow your baby’s cues.
You’ll see that your baby has different patterns
of sucking. At the start of the feed, they’ll have
short, quick sucks until there’s more milk flow.
Later, their suck becomes slower and deeper.
Your baby will pause between these bursts of
sucking and you’ll hear and see them swallow.
Burp your baby after they’ve finished feeding on

the first breast, then offer the second breast and
© Crown copyright 2010, Produced by COI for the
burp them again if they feed on that side. Department of Health, Great Britain.
If you need help keeping your baby awake, change their diaper before offering the second
breast. Remember to wash your hands after the diaper change and before feeding your
baby again.
Your baby may want to feed on the second breast for a shorter time or may not want to
feed at all. Follow your baby’s cues. It’s usually time to change breasts when your baby:
■■ pulls off your breast and looks for more milk
becomes restless at the breast
Take care of your
■■
■■ is not sucking or swallowing as much baby’s mouth

Wipe your baby’s mouth with a
If your baby fed from both breasts, start the
clean damp cloth after each feed.
next feeding with the breast that your baby
This will help them have healthy
last fed from. If your baby fed from only gums and help prevent tooth decay.
one breast, start the next feeding with your
other breast.

If your baby needs help coming off your
BREASTFEEDING
breast, put a clean finger into the corner of Hands and nails
their mouth and push down lightly to break Keep your nails short while you’re
the suction. Your nipples will get sore if you breastfeeding. Make sure your hands
pull your baby off your breast without first and nails are clean when handling
and breastfeeding your baby.
breaking the suction.
Is my baby getting enough?

You can tell if your baby is getting enough breastmilk by the number of wet and dirty
diapers they have.
Age Wet diapers in 24 hours Stools in 24 hours

Birth–24 ■■ at least 1 small, wet diaper ■■ at least 1 meconium stool
hours ■■ small amounts of dark orange
or rusty looking urine
24–48 ■■ at least 2 small, wet diapers ■■ at least 1 meconium stool, each the size of
hours ■■ small amounts of dark orange the palm of your baby’s hand or larger
or rusty looking urine
48–72 ■■ at least 3 wet diapers ■■ at least 3 black green-yellow (transitional)

hours ■■ small amounts of dark orange stools, each the size of the palm of your
or rusty looking urine baby’s hand or larger
3–5 days ■■ at least 4 large, heavy wet ■■ Day 3: at least 3 black green-yellow stools,
old diapers every 24 hours each the size of the palm of your baby’s
■■ amount of urine will increase hand or larger
and turn a light yellow and ■■ Day 4 and 5: at least 4 yellow seedy stools
clear every day, each the size of the palm of your
baby’s hand or larger
6 days and ■■ at least 6 large, heavy wet ■■ at least 4 yellow seedy stools every day,
older diapers every day each the size of the palm of your baby’s
hand or larger
■■ after 4 weeks, your baby’s stools continue
to be soft, yellow, seedy and easy to pass.
After this, the frequency will vary with age.
Here are other ways to tell if your baby is getting enough milk after they’re 72 hours old:
■■ Your breasts will feel smaller and softer after feeds.
■■ Your baby will wake on their own to feed at least 8 times in 24 hours.
■■ You can hear or see your baby swallowing and their jaw moving.

Call Health Link at 811 or your health care provider if your baby has any
of the following:
■■ vomits most or all of their feeding, ■■ green, watery bowel movements
2 or more times in a row that smell bad
! ■■
■■
does not have the recommended
number of wet or dirty diapers
is fussy during or after feeding
■■
■■
white, light grey, or very light
yellowish bowel movements
blood in their stool or urine
■■ wants to feed all of the time—this is ■■ urine that still looks dark orange or
different than cluster feeding rusty after they’re 72 hours old
■■ any other signs that concern you
Call Health Link at 811 or your health care provider NOW if your baby has
!
■■ will feed if you wake them, ■■ is always sleepy
but will not wake up on their ■■ will not feed or is not showing
own to feed feeding cues
Bowel movements
Here are what a breastfed baby’s bowel movements look like in the first 72 hours after
birth. Breastfed babies do not usually get constipated or need medicines like suppositories,
if they’re getting enough breastmilk.
Meconium stool—birth to 48 hours old Transitional stool—48 to 72 hours old
Stool—after 72 hours old Stool—yellow seedy stools

Burping your baby
BREASTFEEDING
Babies often swallow some air when they’re feeding and burping helps them get this air
out of their stomach. There is more than one way to burp your baby:
Over your shoulder

■■ Hold your baby close to your body,
facing over your shoulder.
■■ Put a cloth on your shoulder in
case your baby spits up milk.
■■ Gently pat or rub their back.
Sitting on your lap

■■ Sit your baby in your lap and
support their head with one hand
under their chin.
■■ With your other hand, gently pat or
rub their back.
Laying on their tummy

■■ Lay your baby on their tummy over
your legs.
■■ Support their head as needed and
gently pat or rub their back.

Keep your baby safe during sleep
Taking your baby into bed for feeding or for comfort is risky if you fall asleep. Lying down
to feed is an effective feeding position for many moms. However, it’s easier to fall asleep
if you’re in this position, especially if you’re tired. To stay awake while feeding your baby in
your bed, try wiping your face and neck with a wet cloth or keeping the room lights, TV or
music on. Put your baby in their own crib, cradle or bassinet if you feel sleepy.
If you choose to sleep with your baby on the same sleep surface (bed share) or feel you
may fall asleep while feeding your baby, follow these recommendations about bed sharing
and how to do it as safely as possible to reduce some of the risks.
■■ never sleep with your baby on any soft or padded surface such as a sofa, upholstered
chair, bed with a soft mattress or bedding, water or air-filled mattress
■■ keep bed covers, blankets and pillows far away from your baby
■■ make sure you and your partner know when your baby is in the bed with you at all times
Never sleep with your baby if you or your partner:

■■ smoke
■■ have taken alcohol, cannabis, other drugs, or any prescription, over-the-counter or herbal
medicine that makes you less able to respond to your baby’s needs
■■ are overtired from stress or lack of sleep
If you choose to bed share, make sure you follow all the information provided. Taking these
steps may reduce some of the risk, but it does not make bed sharing safe.

Expressed Breastmilk
BREASTFEEDING
Some women may want or need to use expressed breastmilk with their baby, while others
may not need to express breastmilk at all. There are many reasons why you may want to
express your breastmilk. Expressing your breastmilk will:
■■ help build and keep your milk supply
■■ collect breastmilk for your baby as needed
Expressing and pumping can be
■■ help keep you more comfortable if your a lot of work. Here are some ways
breasts are full or engorged you can help:
Other reasons you may need to express your ■■ Bring a warm moist cloth to your
partner for their breasts before
breastmilk:
they begin pumping.
■■ your baby is not able to latch ■■ Put music on to help them relax.
■■ your baby is sick or born preterm ■■ Take care of your baby.
■■ you’re going to be away from your baby
for longer than 2 hours
■■ you go back to work before your baby has weaned (stopped breastfeeding)
You’ll find it easier to express your milk after:

■■ your baby has breastfed
■■ your baby’s first feed in the morning—this is
when you have more milk
■■ you put a warm, moist cloth on your breasts
■■ you use gentle breast massage
■■ you’ve touched or cuddled your baby
At first you may only be able to express very small amounts of milk. One breast may make
more milk than the other. As you become more comfortable with expressing by hand or
with a breast pump, your milk will flow more easily. After a few days, your milk supply will
increase. The amounts may be different each time you pump.
Tips when you express breastmilk:

■■ Choose a comfortable place.
■■ If your baby is not with you, take reminders of them along, such as a piece of clothing
with their scent or a recording of your baby that you can listen to or watch.
■■ Use relaxation techniques before and while expressing, such as music and deep breathing.

Breast massage
Massaging your breasts before expressing milk will help you start your milk flowing, may
help you remove more milk and increase your milk supply. You can also do breast massage
before and while your baby is feeding.
When doing breast massage:

■■ Always handle your breasts gently so you do not damage the delicate tissue.
■■ Put a warm cloth on your breast before massaging.
■■ Support your breast with one hand and massage with the other.
■■ Spread your fingers and place the flat part of your fingers palm side down on
your breast.
■■ Massage your breasts in small circular motions, from your chest towards your nipple and
massage your entire breast.

Expressing by hand
BREASTFEEDING
Expressing breastmilk by hand is a skill that takes practice. You may not get much milk at
first. Even expressing a small amount of milk will signal your body to make more. It may be
easier to practice in the bathtub or shower, or after breastfeeding your baby.
To express by hand:
1. Wash your hands with soap and warm water.
2. Put a warm cloth on your breasts, then gently
massage them before you start to express.
3. Put your thumb on top of your breast, not too close
to your nipple. Your thumb and index (pointer)
finger need to be opposite to each other and about
2.5–4 cm (1–1½ inches) back from the edge of
your areola.
4. Lift your breast slightly with the fingers that are under your breast. Push straight back
in towards your chest and gently squeeze your thumb and fingers together, rolling
them forward towards your nipple. Keep doing this until your milk starts to flow. Do not
squeeze the base of your nipple— this will stop the flow of milk.
5. Repeat steps 3 and 4 a few times in each position as you rotate your hand around your
nipple and areola like a clock. If you’re not getting any milk flow, move your fingers back
a little. Keep doing this until the milk flow slows and your breast feels soft.
6. Repeat with your other breast.
Gently push in towards Squeeze your thumb Gently roll your fingers
your chest and fingers together toward your nipple
To learn more about hand expression, visit the Videos section at


Expressing with a breast pump
Breast pumps work to express breastmilk by imitating your baby’s sucks. There are different
types of pumps you can use.
■■ Manual (hand), battery-operated or small electric
pumps are used when you pump only once in a
while and after your milk supply is established.
■■ Hospital-grade electric pumps are used when
you‘re not able to breastfeed for some time or
if your baby is not regularly breastfeeding, or if
you’re having problems with breastfeeding. These
pumps are better for establishing and maintaining Manual breast pump
your milk supply than manual pumps. You can rent
these pumps.
If you’re expressing milk while at the birth centre,

there may be a hospital-grade electric pump for you
to use. Ask your nurse to show you where they are
and how to use them.
Here are some tips for pumping breastmilk:

■■ Follow the manufacturer’s instructions for using Electric breast pump
and cleaning your breast pump.
■■ Only use as much suction as needed to get your milk to flow—pumping should
not hurt.
■■ Centre your nipple in the nipple tunnel—it should not press against the sides.
■■ It could take a few minutes for your milk to
start flowing. Expressing breastmilk
■■ If you’re pumping one breast at a time, switch You may find that expressing
between your breasts several times. your milk by hand works well
for you or you can buy or rent a
■■ Pumping both breasts at the same time will breast pump.
help you pump more milk.

Storing and preparing expressed breastmilk
BREASTFEEDING
At the birth centre
When your baby is at the birth centre, your breastmilk needs to be handled safely. When
storing breastmilk at the birth centre:
■■ Ask your nurse for bottle labels that have your baby’s name and your birth centre
identification (ID) number on them.
■■ Put your breastmilk into the bottles you’re given.
■■ Write the time and date you expressed on the label.
■■ Ask your nurse to store the labelled breastmilk in a secure refrigerator or freezer
right away.
■■ If you express breastmilk at home while your baby is at the birth centre, follow the
guidelines below. Put your breastmilk in your refrigerator right away. Use ice or freezer
packs to take your breastmilk to the birth centre.
To make sure your baby gets your breastmilk, check that the bottle you store it in has your
birth centre ID number on it. The bottle label will be checked with your baby’s birth centre
identification bracelet at the bedside by 2 people before the breastmilk is given to them.
At home
Here are some guidelines for preparing and storing breastmilk at home:
■■ Always use clean feeding equipment ■■ Chill fresh breastmilk for 1 hour in a
(see page 300). refrigerator before adding it to a con-
■■ Write the date you expressed your tainer with already frozen breastmilk.
breastmilk on the container with a ■■ If freezing, leave a 1.5 cm (1/2 inch) space
waterproof marker. at the top of the container, as breastmilk
■■ Store your breastmilk in the amounts expands when it’s frozen.
your baby needs for one feeding. ■■ Keep your breastmilk cool or frozen while
■■ Refrigerate or freeze freshly expressed travelling.
breastmilk that’s not going to be used ■■ If you express breastmilk while you’re
right away. away from home, store it in an insulated
■■ Do not mix warm expressed breastmilk cooler bag with a frozen gel pack for no
with cooled or frozen expressed more than 24 hours.
breastmilk.

You can add new breastmilk to already chilled or frozen breastmilk. Cool it first before
adding it, so that it does not warm the already stored breastmilk. Keep the original
expressed breastmilk date on the container if you
add more breastmilk to it on a different day. Always
Check the date
use the breastmilk that’s been frozen the longest
Check the date on the container
first, even if you’ve added fresh breastmilk to it.
with expressed breastmilk. Use
For more information on supplementing, see the one that’s been stored the
longest first. Throw out any that
page 318.
are past the storage time.
Storing expressed breastmilk

Here are some guidelines on where and how long you can store your breastmilk.
Where it can be stored How long it can be stored

At room temperature Up to 4 hours
In an insulated cooler bag with a frozen gel pack Up to 24 hours at 4 °C (39.2 °F) or lower
In the refrigerator—not in the door Up to 3 days (72 hours)
In the freezer of a 1-door refrigerator Up to 2 weeks
In the freezer of a 2-door refrigerator or a side- Up to 4 months

by-side refrigerator
In the chest or deep freezer Up to 12 months at -18 °C (-0.4 °F) or lower
Thawing breastmilk
To thaw breastmilk quickly, put it under cool or warm running water or in a pot of warm
water. If you do not need it right away, thaw the milk in the refrigerator. When using
thawed breastmilk:
Gently shake the milk to mix it back
Microwaves
■■
together—the fat in breastmilk may separate

Thawing or warming breastmilk
during thawing.
in a microwave is not
■■ Refrigerate breastmilk after thawing and use recommended. Microwaves
it within 24 hours. Throw it out if it’s not used heat milk unevenly and form hot
within 24 hours or if your baby does not finish it. spots. This can burn your baby’s
mouth and destroy the immune
■■ Do not refreeze breastmilk that’s already components in breastmilk.
been thawed.

Warming breastmilk
BREASTFEEDING
Your baby may prefer warm breastmilk. Feed breastmilk using a dropper, spoon, cup or
bottle. If you’re using frozen breastmilk, thaw before warming. Here’s how to safely warm
breastmilk:
■■ Put the container of breastmilk in a pan of warm water for no more than 15 minutes.
■■ Do not cover the lid or nipple with water when it’s being warmed. This can contaminate
the breastmilk.
■■ Gently shake the container to mix it.
■■ Test the breastmilk on the inside of your wrist to make sure it’s not too warm to feed
your baby. It should feel lukewarm to the touch.
■■ Do not put the bottle nipple in your mouth to check the temperature or to clean it. This
can pass germs to your baby.
Feeding breastmilk by bottle

When you feed your baby breastmilk from a bottle:
■■ Hold your baby almost upright in your
arms, using skin-to-skin cuddling. Choose low flow nipples
■■ Hold your baby’s cheek to your breast Low flow nipples help your baby
coordinate their sucking, swallowing
to feed.
and breathing.
■■ Change the arm you use to hold your
baby at each feed—just as you would ■■ When your baby’s ready, put the nipple
when breastfeeding. deep enough into their mouth until
■■ Always hold your baby until they’re they have a wide latch—your baby
finished their feed. Never leave your baby should not gag.
alone with a bottle in their mouth—they ■■ Babies will usually feed for 15–30 minutes
can choke. at each feed. If your baby drinks too fast,
■■ Choose a low flow nipple with a tip the bottle down to slow their feed or
single hole. remove it. Your baby should not gasp,
■■ Tip the bottle so the expressed breastmilk cough or cry while bottle feeding.
just fills the nipple. ■■ Burp your baby when they’re finished
■■ Let your baby seek the nipple. Follow feeding (see page 291).
their feeding cues.

Let your baby control the flow of milk and follow their feeding cues. You can tell if your
baby is swallowing too fast, when:
■■ they are not taking a breath between swallows
Leftover breastmilk
■■ their eyes are opened wider than usual
Throw away any breastmilk left
■■ their nostrils are flaring in the bottle after 2 hours. The
■■ their arms and legs are stiffening as they struggle breastmilk can grow bacteria in
it from your baby’s saliva.
to breathe and feed at the same time—they’ll
come off the breast if they cannot breathe
■■ breastmilk is leaking from the sides of their mouth
Follow your baby’s cues. When they’ve had enough they’ll:

■■ stop or slow down their sucking or swallowing
■■ let go of the nipple
■■ look relaxed
■■ stop showing feeding cues
■■ may fall asleep
Feeding equipment
You’ll need to clean all of the feeding equipment if you’re supplementing your baby. This
includes things such as cups, bottles, bottle nipples, caps, tongs and spoons. Follow the
manufacturers’ instructions for use.
Use glass bottles or BPA-free plastic

Can you boil your
containers. BPA is a chemical used in feeding equipment?
some plastics that may not be safe for
Choose equipment, bottles and
young children. Baby bottles purchased
bottle nipples that can be boiled
in Canada after 2010 do not contain BPA. If after each use. Bottles or nipples
buying plastic baby bottles outside of Canada that have warped, melted,
or any other plastic containers make sure they’re or became sticky after being
BPA-free. Check the package or call the manufac- boiled are a choking hazard and
turer if you’re not sure if it has BPA in it. To learn should not be used.
more about BPA-free plastic, visit the Links section
Check the bottle nipples before each use for signs of damage, such as tears, cracks,
swelling or stickiness. These could be a choking hazard for your baby.

Cleaning feeding equipment
BREASTFEEDING
To keep your baby safe, clean all of the feeding equipment you’ll use like tongs, measuring
cups, bottles and nipples. Young babies are at higher risk of getting sick because their
immune systems are still developing. How you clean the equipment depends on if your
baby is under or over 4 months old.
For babies under 4 months old

Clean the feeding equipment before you use it. Feeding equipment is not fully clean until
it has been boiled or has gone through the sanitation cycle of a dishwasher.
If you do not use the cleaned bottles right away, wait until they’re completely dry and
then fully assemble them so the insides stay clean. Store all feeding equipment in a clean,
protected area.
Clean by boiling

Clean by dishwasher
You can also use the sanitize cycle on a dishwasher to clean the feeding equipment if:
■■ There’s a National Sanitation Foundation (NSF) symbol on your dishwasher.
You can also check online to see if the dishwasher is nsf 184 certified.
■■ The dishwasher has a sanitize feature. Use the sanitize cycle.
If you do not use the cleaned bottles right away, fully assemble them once
they are completely dry so the inside stays clean. Store all feeding equipment in a clean,
protected area.
For babies over 4 months old

All feeding equipment should be cleaned before and after every use with hot, soapy
water—boiling is no longer needed. You can also use your dishwasher.
To clean the equipment

1. Wash your hands well with soap and warm water for at least 20 seconds.
2. Use hot soapy water to clean and remove any residue on the equipment. Rinse in
clean water that’s safe to drink. If using a dishwasher, use the longest, hottest wash and
dry cycle.
3. Air dry the equipment on a clean paper towel or clean cloth.
If you do not use the cleaned bottles right away, fully assemble them once they
are completely dry, so the inside stays clean. Store all feeding equipment in a clean,
protected area.

BREASTFEEDING
Eating
You may feel more hungry and thirsty Track your servings
while breastfeeding your baby. Eat a
My Food Guide Servings Tracker
variety of foods from Canada’s Food can help you keep track of the
Guide. An extra 2–3 servings, about amount and type of food you eat
350–400 extra calories, each day from while breastfeeding.
any of the four food groups will help To learn more, visit the Printables section at
meet your needs. Try to drink enough healthyparentshealthychildren.ca/resources
fluids to keep you from feeling thirsty.
Small amounts of caffeine are fine for
most people when breastfeeding. Try to limit your caffeine intake to 300 mg per day or
less. For more information about caffeine, see page 43.
If you’re vegan, vegetarian, or on a restricted diet, you and your baby may need certain
extra vitamins and mineral supplements. Call Health Link at 811 or talk with your health
care provider to find out more.
Omega-3 fats are important for your baby to grow and develop. Eating fish high in
omega-3 fats will increase these fats in your breastmilk. Canada’s Food Guide recommends
eating at least 2 servings of cooked fish and shellfish per week. One food guide serving is
75 g (2½ oz).
Some fish are high in mercury, which can harm the developing brain and nervous system
of infants and young children. For a list of fish that are higher in mercury as well as some
“
safer fish alternatives, see page 42.
Most breastfeeding babies are not bothered Every time you sit down to feed
by what you eat. The only foods you should
”
the baby, you can eat and drink
not eat are the foods that you or your baby
and feed yourself too.
are allergic to. If you think something you’re
eating is bothering your baby, talk with your ~ Sara, mom of a toddler

Medicine, supplements and herbal products
Before taking any prescription or over-the-counter medicine, supplements or herbal
products, talk with your health care provider to ensure they’re safe to take while breast-
feeding. Many medicines may be safe to take when used as directed. Some herbal teas
and herbal products can act like medicine and may affect you and your baby.
To learn more about medicine, supplements, herbal teas and products, call Health Link
at 811, the Medication & Herbal Advice Line toll-free at 1-800-332-1414, or visit the Links
Alcohol
Drinking alcohol is not advised while breastfeeding. Alcohol passes into your breastmilk
and then to your baby. The level of alcohol in your breastmilk is the same as the level in
your blood. Drinking alcohol can also decrease the amount of milk your body makes.
Alcohol in breastmilk can affect your baby’s brain development.
If you choose to have an occasional alcoholic drink, breastfeed before you have a standard
drink. A standard drink is 148 ml (5 oz) of wine, 341 ml (12 oz) of beer or 44 ml (1 1/2 oz) of
liquor. After drinking, wait until the alcohol has left your breastmilk before breastfeeding
again—this usually takes around 2–3 hours for a standard drink. Express your milk during
this time if you’re uncomfortable. This expressed breastmilk should not be fed to your
baby.
You may want to plan ahead if you know that you’re going to have an alcoholic drink. Have
expressed breastmilk available in case your baby is hungry before the 2–3 hours are up.
If you choose to drink more than one occasional alcoholic drink, talk with your health care
provider about how to reduce your baby’s exposure to alcohol through your breastmilk. To
learn more, call Health Link at 811.

Nicotine from tobacco passes into your breastmilk. It can make your baby more likely to
refuse feedings, be fussy, sleep poorly and spit up. The best thing you can do for you and
your baby’s health is to cut down or quit using tobacco.
If you choose to use tobacco, it’s still important to breastfeed, as breastmilk has many
benefits. Try to breastfeed your baby first, before you use tobacco, so that less nicotine
passes through your breastmilk to your baby. Before you use tobacco, put on clothing, like

a jacket or sweater, that acts as a barrier to smoke and vapour. Take it off after. After you
BREASTFEEDING
use tobacco, remember to wash your face and hands and remove or change your clothing
before holding and cuddling your baby. This will reduce your baby’s exposure to second-
and third-hand smoke.
When your baby has periods of cluster feeding, often in the evening, do your best to try
and skip a cigarette, but never a feeding. Be ready for when this happens. Make a list of
ideas that help you cope with stress for when you plan to skip a cigarette. Put the list up
somewhere easy to see so it’s there when you need it.
Making changes in your life is a process that can take time. You may make changes, make
progress and then slip back to old habits again. Remember, each time you try to change,
you learn more about what gets in your way and what helps you succeed. This means
you’re more likely to succeed the next time. Keep trying. Small steps matter.
For help quitting tobacco:

■■ Ask for support from your partner, family or friends.
■■ Call the AlbertaQuits confidential helpline toll-free at 1-866-710-QUIT (7848).
■■ Make a plan for how you’ll cope with stress.
To learn more visit the Links section at healthyparentshealthychildren.ca/resources
Cannabis
There is no known safe amount of cannabis (marijuana, hashish, hash oil) to use while
breastfeeding. If a mom uses cannabis, it could affect her mood, judgment and how she
supervises and cares for her baby. It could also affect her ability to breastfeed and respond
to her baby’s feeding cues.
THC from cannabis is passed into breastmilk and is stored there. If this breastmilk is given
to the baby, the THC is passed to them. The THC is then taken into their brain and fat
cells and can stay in the baby’s body for weeks. There is limited research on the effects
of cannabis on a breastfed baby. Some research shows that THC can affect a baby’s brain
development and cause them to have slower movements and reactions. More research
is needed on the possible effects of cannabis use and breastfeeding. Until more is known
about it, using cannabis while breastfeeding is not advised.
Cannabis smoke also has many of the same harmful chemicals as tobacco smoke.
Second-hand cannabis smoke can cause babies and young children to be sick and it can
affect their level of alertness, understanding and judgment. If someone around you uses

cannabis, it’s important for them not to smoke or vape cannabis in your home, in your
vehicle, or in any closed spaces around your baby and other children.
For information about cutting down, quitting or finding a safer alternative if you use
cannabis for medical reasons, talk with your health care provider. To learn more, you can
also call the Addiction Helpline 24/7 toll-free at 1-866-332-2322, or visit the Links section
Other drugs
Using other drugs such as ecstasy, methamphetamines, cocaine, heroin and fentanyl is not
recommended while breastfeeding. These drugs can pass through your breastmilk to your
baby and effect their health and well-being.
If you’re concerned about your own or someone else’s drug use, talk with your health care
provider. To learn more, see page 74 or visit the Links section at
Thinking and decision making

Alcohol, cannabis and other drugs can affect how you think and make decisions.
To learn more about alcohol, cannabis and other drugs, and cutting back and quitting,
call the Addiction Helpline 24/7 toll-free at 1-866-332-2322, or visit the Links section at

Challenges and What To Do
BREASTFEEDING
If you have breastfeeding challenges, you’re not alone. Challenges are common in the
first few weeks. Be gentle with yourself as you learn and build confidence. Breastfeeding
is a personal experience and there’s no ‘one size fits all’ approach to handling challenges.
Some of the common challenges that can happen while breastfeeding and some tips you
can try are included in this section. If you have any questions, call Health Link at 811 or talk
with your health care provider.
“ Know what your resources are before you even have the baby. Does your
doctor’s clinic have a breastfeeding clinic or where is one you can self-refer?
”
Know all the resources you can use so that when the baby is there, you already
know where these supports are.
~ Amanda, mom of a toddler
Call Health Link at 811 or your health care provider if your baby has
■■ has trouble latching ■■ does not make noise when
!
■■ is fussy during or after swallowing after they’re 72
breastfeeding hours old
■■ wants to feed all the time

■■ has hard stools that are
difficult to pass
■■ does not have the number of wet
or dirty diapers for their age
■■ has any other signs that
concern you
Call Health Link at 811 or your health care provider NOW if your
baby has any of the following:
! ■■
■■
is not breastfeeding well or can’t breastfeed
falls asleep after only a few sucks
■■ will not feed or is not showing feeding cues

Sore nipples
During the first week of breastfeeding, your Call Health Link at 811 or
nipples may feel tender, but breastfeeding your health care provider if
should not hurt. While some tenderness is
common during the first week, pain that
does not go away is not normal. Cracked,
! your baby has white patches
that stick to their mouth and
tongue. This can look like
bleeding or blistered nipples are not milk curds.
normal either.
The most common reason for sore nipples is that your baby is not positioned or latched
properly. Sore nipples may also be caused by bacteria or a yeast infection (thrush). If you or
your baby have a yeast infection, both of you will need to be treated, even if only one of
you has symptoms. To learn more about thrush, visit the Links section at
To help prevent sore nipples:

■■ Check your baby’s position and latch. If your baby is not getting a deep latch, take them
off your breast by sliding a clean finger between their gums until the suction is released.
Latch your baby again.
■■ Do not use creams or ointments on your nipples unless your health care provider tells
you to.
■■ Do not use soap on your nipples. This can make them too dry.
■■ Use cotton breast pads, not plastic-lined ones.
Call Health Link at 811 or your health care provider if you have any of
the following:
! ■■
■■
nipples that are red, itchy, burning or cracked
sharp, shooting or burning pain in your breast during and after feeds
■■ nipples that are not feeling better within 1 or 2 days
If you have cracked or blistered nipples:

■■ Breastfeed your baby as soon as they wake up and before they start to cry—it’s okay to
wait to change their diaper until after the feed.
■■ Check your baby’s latch and try different feeding positions.

Massage your breast before and during the feed to help your milk flow.
BREASTFEEDING
■■
■■ Start breastfeeding on the side that’s less sore.

Sore nipples?
■■ Use a warm face cloth or towel on your nipples.
Check your baby’s position
■■ Put some of your expressed breastmilk on your and latch.
nipples to help them heal.
Talk with your health care provider before taking pain medicine, using a breast pump, or
using a nipple shield.
Breast fullness
It’s normal for your breasts to feel full and heavy in the first few weeks as your body makes
more breastmilk. Your breasts will become softer after each feeding.
Sometimes your breasts might become very full and make you feel uncomfortable. Your
breasts may feel firm, warm or tender but your milk will still flow and be easy to express.
Your breasts will feel softer, less heavy and less tender after feeding.
If your breasts feel very full, here are some ways to help you feel more comfortable, help
with milk flow and make it easier for you to breastfeed.
Before breastfeeding While breastfeeding After breastfeeding
■■ Take a warm shower or bath ■■ Massage your breasts. ■■ If your breasts are tender,
just before you breastfeed. ■■ Position and latch your put a cool compress such
■■ Put a warm cloth or towel on baby so that their chin as a gel pack, frozen peas
your breasts. and nose are pointing to or ice that’s wrapped in a
different areas of the breast dry cloth on your breasts
■■ Express a small amount of milk. for 5–10 minutes.
while feeding.
Engorgement
Engorgement is more than breast fullness. It happens when milk does not flow easily from
your breasts. Signs that you’re engorged:
■■ Your breasts are hard, swollen, shiny, painful and red.
■■ Your nipples become flat.
■■ It’s hard to express your milk.
nipple shield: breastfeeding equipment that fits over the nipple and areola

How to prevent engorgement
Feeding your baby often is the best way to prevent engorgement. Other things that
help include:
■■ good positioning and latch
■■ cue-based feedings—at least 8 feedings in 24 hours. Try not to miss any feedings.
■■ breastfeeding for as long as your baby wants
■■ expressing just enough milk by hand or by using a breast pump so you’re comfortable.
Pumping your breasts too much can make it worse as your body will make more milk.
How to manage engorgement

Here are some tips to help you feel more comfortable and make it easier for you
to breastfeed.
Before breastfeeding While breastfeeding After breastfeeding
■■ Put a cool compress such ■■ Help your milk flow by ■■ If your baby does not feed
as a moist towel, gel pack, gently massaging your on your second breast,
frozen peas or ice that’s breasts. express just enough milk to
wrapped in a dry cloth ■■ If your baby is having feel comfortable. Start the
on your breasts for 5–10 trouble latching, you can next feed on this breast.
minutes. Do this as often express some breastmilk ■■ Put a cool compress such
as you can, then gently by hand, or pump some as a moist towel, gel pack,
massage your breasts. breastmilk to soften your frozen peas or ice that’s
■■ Talk with your health breast. wrapped in a dry cloth
care provider about pain ■■ Position and latch your baby on your breasts for 5–10
medicine you can take while so that their chin and nose minutes.
breastfeeding. are pointing to different ■■ If you’re feeling
areas of the breast while uncomfortable between
feeding. feeds, express a little milk
■■ Feed on one breast and until you feel better—
offer your other breast if expressing or pumping
your baby is still hungry. too much milk will make
it worse as your body will
make more milk.
!
Call Health Link at 811 or your health care
provider NOW if these tips do not help
and your breasts are still engorged.

Blocked milk ducts
BREASTFEEDING
Blocked milk ducts happen when there is a
build-up of milk in the breast ducts. These
areas may be tender, lumpy, red and sore.
Blocked ducts that are not drained can
lead to an inflammation of the breast tissue Warm, tender area
called mastitis. Mastitis can also be caused
by an infection.
Areola
To help prevent blocked milk ducts:
■■ Position and latch your baby correctly.
■■ Get help if your nipples are sore and are
not getting better.
Breastfeed your baby often and try
Point baby’s nose and chin to
■■
different feeding positions.

different areas
■■ Try not to miss feedings. Your baby gets the most milk from
■■ Wear a well-fitting bra and comfortable the area where their chin and nose are
clothing. pointing to. Changing the direction
that they’re pointing to will help relieve
■■ Do not wear underwire bras or a bra the pressure in the blocked duct and
to bed. drain milk from different areas.
■■ Wash your hands often.
Here are some things you can do to help you clear the blocked duct:
■■ Feed your baby at least every 2–3 hours ■■ Position and latch your baby so their chin
to keep your milk flowing. and nose are pointing to the tender area.
■■ Put a warm cloth on your breasts for ■■ Try to rest—ask your partner, family and
5–10 minutes before breastfeeding, as friends to help you at home.
this helps with let-down. ■■ Drink enough fluids and eat well.
■■ Use your fingertips to gently massage ■■ Express or pump regularly, if your baby is
from behind the tender area all the not feeding every 2–3 hours and at least
way to your nipple before and during once at night. This will help regularly
breastfeeding. empty your breast if your baby is not able
■■ Have your baby breastfeed on your to breastfeed.
tender breast first, then the other breast. ■■ Talk with your health care provider about
taking pain medicine, if you need it.

Even though you may not feel well, your milk is safe for your baby. Continue to feed your
baby to keep your milk flowing. If the lumps do not soften or decrease with feeding, talk
with your health care provider as you may need additional treatment for mastitis.
Mastitis
Blocked ducts that are not drained can lead to an inflammation of the breast tissue called
mastitis. Mastitis can also be caused by an infection.
Signs that you may have mastitis:

■■ areas of your breast become inflamed and are red, painful, hard and swollen
■■ only one breast is affected
■■ you can feel a lump close to the skin
■■ your breast is tender or hurts around the lump
■■ flu-like symptoms that include a fever of 38 °C (100.4 °F) or higher, chills, and body aches
Here are some things you can do if you have mastitis:

■■ Feed your baby at least every 2–3 hours ■■ Position and latch your baby so their chin
to keep your milk flowing. and nose are pointing to the tender area.
■■ Put a cool cloth on your breasts for ■■ Try to rest—ask your partner, family and
5–10 minutes before breastfeeding, as friends to help you at home.
this helps with let-down. ■■ Drink enough fluids and eat well.
■■ Use your fingertips to gently massage ■■ Express or pump regularly, if you’re baby
from behind the tender area all the is not feeding every 2–3 hours and at
way to your nipple before and during least once at night. This will help regularly
breastfeeding. empty your breast if your baby is not able
■■ Have your baby breastfeed on your to breastfeed.
tender breast first, then the other breast. ■■ Talk with your health care provider about
taking pain medicine, if you need it.
Mastitis can be serious and may need to be treated with antibiotics if it’s due to an
infection. It usually clears up quickly once treated.
Your baby may refuse your breast because your milk may have a different taste when you
have an infection. If this happens, your baby will need to be supplemented. You’ll need to
express your breastmilk to maintain your milk supply during this time.

BREASTFEEDING
Call Health Link at 811 or your health care provider if you have any of the
following when breastfeeding:
■■ trouble with, or unable to ■■ a fever of 38 °C (100.4 °F) or higher
!
breastfeed, express or pump ■■ hard, red and painful breasts
■■ flu-like symptoms such as ■■ red, warm spots or streaks on your
headaches, aching muscles, breasts
chills, feeling tired or other
signs of infection ■■ hard, swollen breast that your baby
has trouble latching to
Breasts leaking milk

After the first few weeks when your milk supply increases, milk may leak from one breast
while your baby is feeding from the other—this is normal. You can either gently press
a clean cloth or towel on your nipple to stop the flow or collect your breastmilk in a
clean container.
Milk may also leak from your breasts between feedings. You may want to use cotton breast
pads to protect your clothes. To help prevent infection, change your breast pads often.
Not enough milk

Women usually make enough milk for their baby. For information on how to tell if your
baby is getting enough milk, see page 289. There are some things that can affect milk
production.
Your body may make less milk if your baby:

■■ is not positioned and latched properly ■■ is only offered one breast at each feeding
■■ is not breastfeeding often enough during ■■ is being supplemented and you’re not
the day or night pumping or expressing your milk
■■ is not breastfeeding long enough at ■■ is feeding with a nipple shield, but you’re
each feeding not using it correctly

Your body may make less milk if you:
■■ lost a lot of blood during or after birth ■■ use certain types of birth control
■■ have had breast surgery, such as a breast (see page 257)
reduction ■■ are in pain or stressed
■■ have certain health issues, such as ■■ drink alcohol
thyroid problems, diabetes or high ■■ are pregnant
blood pressure
■■ take certain medicines, such as
Call Health Link at 811 or your
antihistamines or some herbal teas
!
health care provider if your
Talk with your health care provider if you breasts do not feel full and
think any of the above or something else heavy by the time your baby
may be affecting your milk supply. is 72 hours old.
Herbal product claims

Some herbal products, such as teas, claim to increase breastmilk supply. There is not
enough research around their safety. To learn more, call the Medication & Herbal Advice
Line toll-free at 1-800-332-1414.
Here are some tips to help increase your milk supply:

■■ Spend more time skin-to-skin cuddling ■■ Use breast compression when your baby’s
with your baby. sucking slows down.
■■ Rest when your baby’s sleeping. Ask for ■■ Express milk by hand or using a breast
help with household chores. pump after feedings. Using an electric
■■ Feed your baby at least 8 times in pump together with expressing by hand
24 hours and watch for their feeding cues. will increase your supply more than
pumping on its own.
■■ Offer both breasts at every feeding. Let
your baby finish the first breast before
■■ Use an electric breast pump if your baby
offering the other one. is not breastfeeding well or you’re not
able to breastfeed. Set it at a comfortable
■■ Put a warm face cloth or small towel on setting and use it at least 6–8 times in
your breasts and massage them before 24 hours. Express at least once at night.
and during pumping, hand expressing or
while your baby is feeding.
Call Health Link at 811 or talk with your health care provider if you have any concerns with
not having enough breastmilk.

Breast compression
BREASTFEEDING
Breast compression is a way to gently squeeze your breast during feeding to increase milk
flow. Increasing milk flow can encourage your baby to suck if they fall asleep after only a
few minutes at your breast.
To do breast compression, gently massage

and place your thumb on top of your breast
and the fingers of the same hand below it.
Apply gentle pressure behind your areola for

a few seconds. Do not squeeze so hard that it
hurts. You can do this throughout the feed or
at the end, when your baby gets sleepy.
To learn more about breast compression, visit the Videos section section at
Too much milk

Milk supply is usually affected by your baby’s appetite. Sometimes you may have a larger
milk supply than your baby needs (oversupply).
Signs that you may have an oversupply include:

■■ leaking a lot of milk during and
between feedings Donating breastmilk
■■ feeling your breasts are really full If you have too much breastmilk, you
may be interested in donating it to the
■■ getting blocked ducts often milk bank. To learn more about the milk
bank in Alberta, visit the Links section at
There may be other reasons for healthyparentshealthychildren.ca/resources
having too much milk. If you have
any questions, talk with your health
care provider.
If you have too much milk, your baby may:

■■ gain weight well, but be fussy and always seems hungry
■■ spit up a lot
■■ have explosive, watery, green stools
■■ want to feed often, even after taking large amounts of breastmilk

Here are some tips that may help if you have too much milk:
■■ Use different feeding positions, such as the laid-back position.
■■ Feed your baby as many times as they want.
■■ For 3–6 hours, offer only one breast at each feed. After 3–6 hours, offer the other breast
at each feed. Let the breast you’re not feeding from leak milk and express just enough
milk for comfort. Once your symptoms are better, go back to offering both breasts at
each feed.
■■ Use a cold face cloth or small towel on the breast you’re not feeding on, for no longer
than 20 minutes at a time.
■■ Burp your baby often.
Milk flows too fast

An overactive let-down is when your breastmilk flows too fast. Overactive let-down and
oversupply are often seen together.
Signs that you may have milk that flows too fast include:
■■ pain with the let-down at the start of
the feed Call Health Link at 811 or your
■■ breastmilk spraying from one breast, health care provider if you have
while your baby feeds on the other any of the following:
breast ■■ concerns about your milk
supply
■■ painful nipples from your baby biting
down to slow milk flow ■■ your baby pulls off your breast
!
often and looks like they’re
If your milk flows too fast, your baby may: having trouble breathing
■■ have a poor latch, suck and swallow ■■ your baby chokes, coughs or
■■ push off the breast when your sputters while feeding
breastmilk sprays ■■ your baby has explosive, green,
■■ be fussy and cough, sputter or pull away watery stool
during feeds ■■ your baby spits up more than
usual
■■ come on and off the breast often
■■ you have any other concerns
■■ refuse to breastfeed

Here are some tips to help with a fast milk flow:
BREASTFEEDING
■■ Use positions that put your baby above ■■ Express or pump a little milk before
your breast, such as laid-back. latching your baby.
■■ Respond to your baby’s feeding cues ■■ Release your baby’s latch if they choke or
early, like when they’re just waking up. sputter. Let your milk spray into a cloth
■■ Burp your baby often and take breaks so before your baby latches again.
your baby can pace themselves during ■■ Avoid using warm cloths or towels or
the feed. taking long, warm showers or baths
before breastfeeding.
Sleepy newborn
Some newborns are sleepier than others. A baby may be sleepy because of:
■■ a hard labour and birth
■■ medicine you’re taking
■■ not getting enough breastmilk
■■ too much light and noise (over stimulation)
■■ long periods of crying
■■ illness such as an infection
■■ jaundice or other health reasons
Here are some ways to wake up your baby to feed:

■■ Do skin-to-skin cuddling.
■■ Unwrap or undress your baby, or change their diaper.
■■ Hold them upright while supporting their neck and
Call Health Link at
head, make eye contact and talk to them.
811 or your health
Gently stroke or massage your baby’s body. Move
!
■■
care provider NOW
their arms and legs, stroke their cheek, rub their back if you’re having
or circle their lips with your clean finger.
trouble getting
■■ Express breastmilk onto their lips. your baby to wake
■■ Burp and put them on the same breast to feed until up enough to feed.
your breast feels empty or you hear less swallows.
■■ If your baby falls asleep after only a few minutes at the breast, use breast compression
while breastfeeding to encourage sucking (see page 315). You can do this throughout
the feed or at the end when your baby gets sleepy.

Supplementing
There may be different reasons your baby needs to be supplemented. Talk with your
health care provider if you have any concerns. If you need to supplement, you can use
your own expressed breastmilk or an infant formula along with or in place of breastmilk.
Although some hospitals may have pasteurized and screened donor human milk, there
is a limited supply and it’s used mainly for premature and very sick babies. For others,
you may be able to buy it from a milk bank. To learn more, visit the Links section at
When supplementing:
■■ Keep doing skin-to-skin cuddling with your baby during and after feeding.
■■ If possible, breastfeed first, then offer the supplement. Finish the feed at the breast. This
helps your baby link the feeling of fullness with the breast.
■■ If you use a bottle, choose a nipple that has a slower flow rate and a single hole to help
your baby coordinate their sucking, swallowing and breathing.
■■ If you’re using infant formula, talk with your health care provider about the one that’s
right for your baby. Follow the manufacturer’s formula mixing instructions exactly.
Mixing and storing formula incorrectly could cause serious health problems for your
baby. Information on infant formula can be found in the book Healthy Parents, Healthy
Children: The Early Years or visit healthyparentshealthychildren.ca
■■ Try to express your breastmilk to help keep your milk supply up. If you do not, your milk
supply will decrease.
If your baby no longer needs to be supplemented, you can start exclusive breastfeeding
again. Talk with your health care provider if you have questions or concerns.
Weaning
Weaning (stopping breastfeeding) is a process, not a single event. It starts when you
offer your baby foods other than breastmilk, like formula or solid foods, and ends when
your baby stops breastfeeding. Your baby will gradually begin to eat more solids and
breastfeed less. This may take several weeks or months, depending on you and your baby.
Just as each baby has their own schedule for feeding, they’ll also have their own schedule
for weaning.

Weaning may be led mostly by your baby, mostly by you or by both of you. All of these are
BREASTFEEDING
okay. Listen to your own feelings and read your baby’s cues and you’ll know when it’s the
right time. When it’s time to start weaning, make a plan so you can have a gradual stop
that makes it easier for your breasts to adjust.
If you’re introducing formula, replace only one feeding at a time. Begin by feeding your
baby using a cup or a bottle at a time of day when they’re not as hungry. Your baby may
refuse it at first—offer it again each day. When they’re feeding well, you can start to replace
other feedings.
If you’re weaning when your baby is under 9 months: Questions about

weaning?
■■ Use a store-bought infant formula.
Talk to your health care
■■ At 6 months old, use a cup without a lid for small provider.
amounts of water or infant formula.
Breastfeeding has provided food, security and comfort for your baby. Continue to offer
skin-to-skin cuddles and hugs often during weaning to support your baby through this
change and continue to build your attachment.
If you need to wean suddenly

If you and your baby need to be separated for a long time, such as during an illness,
breastfeeding may need to stop suddenly. Here are some things to help you feel more
comfortable:
■■ Wear a supportive bra.
■■ Use a gel pack, frozen peas or ice that’s wrapped in a dry cloth on your breasts to relieve
fullness, for no longer than 20 minutes at a time.
■■ Express a small amount of milk for comfort if needed. Taking a warm shower may also
help your breasts leak.
■■ Your breasts may soften but will still produce milk for several weeks or months. You can
wear breast pads if your milk leaks.
If you didn’t plan to stop breastfeeding, you may feel a sense of loss. Ask for emotional
support from your partner or friends and family. You can also call Health Link at 811 or talk
with your health care provider for information and support.

When breastfeeding is not advised
In rare cases, it may not be safe to breastfeed, but you might still be able to feed your baby
your breastmilk. This may happen if you have some types of infection, such as herpes
lesions on your breasts.
There may be times when your health care provider advises you not to breastfeed or give
breastmilk to your baby. This may happen if:
■■ your baby has a rare metabolic condition such
as phenylketonuria (PKU), galactosemia or If you have been advised
maple syrup urine disease not to breastfeed
■■ you’re HIV positive This may be an emotional time.
Whatever you’re feeling, be gentle
■■ you’re on chemotherapy or taking other with yourself and ask for help if
medicine that is not safe while breastfeeding you need it.
■■ you’re being given certain radioactive
compounds
■■ you’re misusing prescription medicine or alcohol, or using cannabis or other drugs such
as ecstasy, methamphetamines, cocaine, heroin and fentanyl
If you’re advised not to breastfeed your baby, feed your baby infant formula. More
Information on feeding your baby infant formula can be found in the book Healthy Parents,
Healthy Children: The Early Years or visit healthyparentshealthychildren.ca
If you have questions, call Health Link at 811 or talk with your health care provider.

T H E E A R LY Y E A R S
The Early Years
Whether you’re a new parent, or have been a parent for a while,
you’re likely to have many questions. The Healthy Parents, Healthy Children:
The Early Years book has information to help you on your parenting
journey. It’s your relationship with your child and what you do every day
that really makes a difference.

321
Healthy Parents, Healthy Children:
The Early Years
We’ve written another book for you called Healthy Parents, Healthy Children: The Early Years. It
picks up where this book ends and will help guide you with parenting information from
the newborn stage up to your child’s 6th birthday.
“
In this book you’ll find:
■■ An Overview of Being a Parent gives Having a baby is intense and
you a general look at parenting and some challenging for everyone—but
of the foundational information you every parent will tell you it goes
need to know to begin your parenting
by so quickly—ask for help and
journey, whether you’re parenting with
”
support, but most of all, get to
a partner, on your own or with other
family members.
know your baby.
■■ Healthy Growing Families highlights ~ Danielle, mom of two children

health, safety and development
information for families with babies and
young children.
■■ Feeding Your Baby gives you information about breastfeeding or feeding your baby
commercial infant formula.
■■ Newborns: Birth–2 Months gives you information about caring for your newborn baby
and ideas to help your baby grow, learn, play and be healthy.
■■ Young Babies: 2–6 Months, Older Babies: 6–12 Months, Toddlers: 1 and 2 Year
Olds, Preschoolers: 3 and 4 Year Olds and Young Children: 5 Year Olds are separate
chapters that give you practical ideas to help your child grow, learn, play and be healthy
for their age and stage of development.
If you haven’t already received a copy of Healthy Parents, Healthy Children: The Early Years,
visit your local Community or Public Health Centre to get a copy. You can also visit
Feedback
We want to hear from you. Please email your feedback to us at hphc@ahs.ca

Index
INDEX
A Anterior position, 171, 177, 181-182
Antibodies
Abduction (prevention at birth centre/hospital), 216
blood type, 104
Abstinence, 56, 272
breastmilk, 85, 276-277
Abuse
hepatitis B antigen, 105
call 911, 60
HIV (Human Immunodeficiency Virus), 105
cycle of, 59-60
immunizations, 75
definition, 59
Rh immunoglobulin, 104
family (domestic) violence, 3, 56-60
Anxiety
getting help, 60
postpartum, 224, 246-249
relationships, 55-58
pregnancy, 63-64, 66, 73, 102, 149, 152-153
Activity
Apgar score, 208
See physical activity/exercise
Aspartame, 43
See postpartum (caring for yourself)
Attachment (emotional connection)
Active labour, 166, 169, 171, 174
postpartum, 140, 245, 280, 319
Acupressure (wristbands), 96
pregnancy, 11-12, 103, 140
After pains, 230, 236
Augmentation (of labour), 199
Alberta Adult Health Benefit, 26
Autopsy, 141
Alberta Child Health Benefit (card), 220
Alberta Personal Health Card (number), 157, 159, 220
Alcohol (drinking)
B
brain development (baby), 19, 67-68 Baby/newborn, how they look, 210-213
binge drinking, 68 Baby blues/postpartum blues, 246-247
breastfeeding (while), 304, 314, 320 See also, postpartum (mental health)
Canada’s Low-Risk Alcohol Drinking Guidelines, 250 Baby bottles
Fetal Alcohol Spectrum Disorder (FASD), 67-68 BPA-free, 300
postpartum, 248-250, 292 cleaning, 301-302
pregnancy, 19, 23, 25, 65-68, 109, 138 feeding, 299-300
Allergies storing breastmilk, 297-298, 301-302
latex (condoms), 263-264 Baby clothes, 130, 136, 159
breastfeeding (while), 303 Babysitting (child care), 88, 254
pregnancy (during), 44, 118 Back labour, 181-182, 184
Alternative sweeteners, 43 Backache
Amniocentesis, 125 labour and birth, 167, 178-180
Amniotic fluid/sac (bag of waters), 17, 29, 55, 91, 124-125, 156, pregnancy, 45, 52, 115, 119, 149
198, 202 Bacteria, 38-41, 43, 53, 99, 105, 154, 243, 300, 308
Anemia/low iron, 34 Bag of waters (amniotic fluid/sac), 17, 29, 55, 91, 124-125, 156,
Anesthetic 198, 202
caesarean (c-section), 202-203 Bassinets, 130, 132-133, 215
epidural/spinal, 194, 202-203 Bath (baby), 131, 213
general, 202
local (freezing), 199

Bath (mother) Bleeding, mother (postpartum)
breastfeeding (when), 295, 309, 317 after pains, 230
labour and birth, 167, 184, 193 emergency, 911 (call NOW), 227
postpartum, 226, 229, 231, 236 healthy sexuality, 256
pregnancy, 80, 150 hemorrhoids/rectum, 231
Bed sharing, 215, 292 menstrual period, 230
Belly button/naval, 17, 146 normal/excessive flow, 227-228
Binge drinking (alcohol), 68 Bleeding, mother (pregnancy)
Birth/delivery (second stage), 190-191 changes in you, 93
Birth centre/hospital emergency, 911 (call NOW), 162, 169
birthing rooms, 87, 157 hemorrhoids/rectum, 101
definition, 6 miscarriage (signs of). See miscarriage
emergency, 911 (call NOW), 169 placental abruption, 162
emergency, birth centre (go NOW), 7, 155 preterm labour (signs of), 139, 162
learn about, 157 Blocked milk ducts, 311-312
packing for, 159-160 Blood clot, 77, 109, 192, 227-228, 258-259, 261
going home, 221-223 Blood pressure (mother)
safe (keeping baby), 216 check-ups, 103, 123, 154, 170
when to go to, 169-170 epidural, 194-195
Birth certificate, 220 high, 30, 73, 137, 161, 198, 239, 258-259, 261, 314
Birth control labour and birth, 170, 195, 197-198, 202-203
getting pregnant again, 230, 257 postpartum, 208, 239, 258-259, 261
types, methods, options (choices), 257-272 pregnancy, 30, 73, 103, 123, 137, 154, 161, 202
Birth control (pill), 258 Blood tests (baby), 217
Birth defects Blood tests, mother (pregnancy/prenatal), 34, 103-107, 109,
causes of (possible), 36, 67, 69-70, 72, 74, 83, 104-105 124-125
testing for, 106-107, 125 Blood type, 104, 109
prevention of (folic acid/folate), 34 See also, antibodies
Birth wishes, 127-128, 159, 170 Bloody show, 166, 175
Bladder Body mass index (BMI), 26-29, 37
definition, 17 Bottle feeding (baby), 299-302, 318-319
labour and birth, 166-167, 173, 176, 195, 197, 203 Bowel movements (mother)
postpartum, 233-234, 265 definition, 17
pregnancy, 17, 100 incontinence, 233
Bleeding (baby), 200, 208, 212 labour and birth, 166, 173, 175, 190
Bleeding, mother (labour and birth) postpartum, 231-232, 234
bloody show, 166, 175 pregnancy, 37, 101
emergency, 911 (call NOW), 169 See also, constipation (mother)
separation of placenta after delivery, 192 Bowel movements/stools/poops (baby), 289-290
BPA-free plastic, 300
Bra (breastfeeding/nursing), buying, 135

Brain development, baby (pregnancy/postpartum) Breastfeeding (challenges)
INDEX
changes during, 19-20, 91-92, 94, 115-116, 211, 145-146 blocked milk ducts, 135, 283, 311-312, 315
folic acid, 34 breast fullness, 309
harmed by 19, 40, 61, 67-75, 78, 105, 208, 252, 303-305 call Health Link at 811 or your health care provider,
omega-3-fats, 36 (NOW), 310
Braxton-Hicks contractions, 55, 113, 116, 147, 150, 166 engorgement (engorged), 226-227, 309-310
Breast compression, 314-315, 317 leaking milk, 313
Breast engorgement, 227, 309-310 mastitis, 311-313
Breast fullness, 309, 319 milk flows fast, 316-317
Breast massage, 294 not advised (when it’s), 320
Breastfeeding not enough milk, 313-315
alcohol, 304, 314, 320 sleepy baby, 317
benefits of, 85, 275-276 sore nipples, 308-309
bras (nursing), 135 too much milk (oversupply), 315-316
breast pumps, 135, 196 Breastmilk, supply (production)
burping, 291 affected by, 210, 257-259, 261, 277-279, 294, 313-316,
call Health Link at 811 or your health care provider, NOW, 318-319
290, 307, 317 changes in milk (colostrum, transitional, mature), 277
cannabis (marijuana). See cannabis establishing, 210, 277-279
cluster feeds, 287, 305 pumping, 218, 296
compression (breast), 314-315, 317 Breathing techniques, 62, 184-187
cues (feeding), 280-282 Breech (position/presentation), 200-201
deciding, 85-86 Burping (baby), 291
diapers, wet (pee/urine) and bowel movements
(meconium/poops/stools), 277, 289-290 C
drugs (other), 306
Caesarean birth (c-section/incision)
eating healthy, 303
definition, 30, 201
exclusive breastfeeding, 85, 230, 276, 279, 293
incision care, 236
expressing and storing breastmilk, 293, 295-298
labour and birth, 201-204
feeding expressed breastmilk (how to), 299-302
postpartum care, 203-204, 208, 225-226, 229, 236-237
goals, 275
reasons for, 201-202
growth spurts, 276, 278, 287
Caffeine (coffee, tea, energy drinks)
how breasts make milk, 277
breastfeeding (while), 303
how long/often (frequency) to feed, 286, 289
pregnancy, 43, 96-97, 151
latch, 285-286
Calcium, 35, 43, 85, 275
massage (breast), 293-295
Campylobacter jejuni (campylobacteriosis), 39
medicine, supplements and herbal products, 304
Cannabidiol (CBD)/medicinal marijuana, 73
multiples (feeding twins, triplets and more), 278
Canada Child Tax Benefit, 219
pads (nursing/breast), 135, 308, 313, 319
Canada’s Food Guide
positions, 282-286
breastfeeding (while), 303
safety/bed-sharing (keeping baby safe), 292
pregnancy, 30-31, 35-37, 117, 148
supplementing, 318
See also, eating (mother)
tobacco and tobacco-like products, 304-306
Canada’s Low-Risk Alcohol Drinking Guidelines, 250
vitamin D (baby), 275
weaning (stopping), 318-319

Cannabis, marijuana, hashish, hash oil, weed, pot Constipation (mother)
breastfeeding (while), 250, 305-306, 320 definition, 34
Cannabidiol (CBD)/medicinal marijuana, 73 postpartum, 229, 234, 237
postpartum, 252, 292 pregnancy, 36-37, 45, 93, 101, 114, 115
pregnancy, 19, 23, 25, 73-75, 138, 152 Contraception (birth control), 257-272
Tetrahydrocannabinol (THC), 73, 305 Contractions
Car seats back labour, 181-182, 184, 195
birth centre (packing for), 159 body preparing for, 165-167
buying, 133-134 Braxton-Hicks contractions, 55, 113, 116, 147, 166
prevent injuries (mother), 240 emergency, 911 (call NOW), 169
using, YES Test, 221-223 emergency department (go NOW), 108
Cat litter, 80 monitoring (fetal), 196-200
Catheter, 107, 194-195, 197, 203 orgasm, 102
Cervix preterm labour, 139, 162
birth control, 257, 262, 265 definition, 17 progression through labour, 171-176
labour, 166, 168, 170-175, 183, 190, 197-198, 201 prenatal, timing (how to), 170
103, 107, 109, 154 what they’re like, 168
Checkups when to go to birth centre, 169
baby, 225 working with your body during labour, 176-187
mother, 25, 103, 123, 154, 225 Contractions (postpartum)
Chemicals and hazardous substances, 19, 43, 68-69, 73-74, after pains, 227, 230
83-84, 109, 251, 305 breastfeeding (uterus contracts), 276
Chicken pox, 76, 104 Cord blood (stem cells), 129
Childbirth classes, 87-88, 126 Cord prolapse, 162, 169, 202
Child care, 88, 173, 254 emergency, 911 (call NOW), 162, 169
Child safety seat. See car seats Cradles, 130, 132-133, 215
Chlamydia, 56 Cramps
Chorionic villus sampling (CVS), 107 abdominal, 139, 162
Cigarettes, See tobacco and tobacco-like products after pains (postpartum), 230, 236
Circumcision, 129 legs, 45, 116, 120, 147, 149
Cleaning products/household cleaners, 83 labour and birth, 168, 188
Clothing (baby), 130, 133, 159 menstrual (birth control), 260, 262
Cluster feeds, 287, 305 preterm labour, 139, 162
Cocaine, 19, 74, 252, 306, 320 stomach (food poisoning), 39-40
Coffee/caffeine, 43, 96-97, 151, 303 Cravings (pregnancy), 99
Colostrum, 85, 114-115, 145, 277 Cribs, cradles and bassinets, 130, 132-133, 215
Community health nurse/public health nurse, 142, 214, 221, Chromosome(s), 103, 106, 125
225, 279 Crowning (of baby’s head), 191
Condom (male), 56, 78, 257, 263, 266-267, 271-272 Crying (baby), 213-214, 281, 317
Condom (vaginal), 56, 78, 257, 264, 266-267, 271-272 Crying (mother), 63, 93
Conception, 16 C-section. See caesarean birth
Constipation (baby), 290

Cues (baby) Dizzy/dizziness (mother), 66, 80, 98, 106, 147, 188, 193-194,
INDEX
crying, 213-214 216, 249
definition, 213, 278 Doctor/physician/obstetrician, 18, 24, 225
feeding, 279-282, 286-290, 299-300, 305, 307, 314, 317 Douching, 119
weaning, 319 Down syndrome (prenatal tests), 106-107, 125
CVS (chorionic villus sampling), 107 Driving safe (seat belts), 79
Cystic fibrosis, 217 Drugs (illicit, street), 74-75
Cytomegalovirus, 75 Due date, 18, 156, 161, 169
D E
D vitamin (baby). See vitamins and minerals Early dating ultrasound, 106
Day care, 88, 173, 254 Eating (baby). See feeding your baby
Delivery of baby (second stage), 190-191 Eating (mother)
Delusions, 250 cravings, 99
Dental care (teeth and mouth care), 53, 95, 99, 156 food poisoning/safety, 38-40
Dental hygienist, 53, 99 foods to avoid, 41-42
Dentist, 23, 53, 95, 99, 117, 156 healthy eating, 30-37, 64
Depo-Provera (birth control injection), 260 labour and birth, 173
Depression postpartum, 238
baby blues/postpartum depression, 246-249 weight gain, 26-30, 37, 95, 117, 148
pregnancy, 54, 63-66, 73, 102 while breastfeeding, 303
Development, baby (changes during pregnancy), 11, 19, See also, vitamins and minerals (mother)
91-92, 94, 114-116, 145-147 E-cigarettes (electronic cigarettes), 69
Diabetes/testing (glucose tolerance), 30, 33, 45, 124, 137, 198, See also, tobacco and tobacco-like products
239, 314 E.coli (Escherichia coli), 39, 41
Dilation of cervix, 171-172 Ecstasy, 74, 252, 306, 320
See also, labour and birth (first stage) Egg release (ovulation), 230, 257-262, 268
Dilation and curettage (D and C), 109 Effacement, 171
Diapers (cloth, disposable), 131, 159, 289, 290 Effleurage, 184
Diaphragm Ejaculation, 269-270
birth control, 257, 265 Electrode, 193, 197
muscle (breathing), 150 Electronic cigarettes (e-cigarettes), 69
Diarrhea See also, tobacco and tobacco-like products
food poisoning, 39-40 Embryo, 16, 91
labour, 166 Emergency
preterm labour, 139, 162 911 (call NOW), 3, 60, 120, 162, 169, 227, 235, 248, 250
Dietitian, 39 birth centre (go NOW), 155
Discomforts (mother) department (go NOW), 108, 232
postpartum, 227-237 Emergency contraception (EC), 271
pregnancy, 45, 73, 96, 117-118, 149-150, 152, 182 Emotions
Discrimination at work (working/employment), 81-82 labour and birth, 173-175, 187
Diseases (infectious). See infectious diseases postpartum, 140-142, 224, 226, 244-250, 253-254
Diuretics, 100 pregnancy, 54, 59, 61-66, 92-93, 102, 121-122, 152-153
See also, mental health

Emotional connection (attachment), 11-12, 103, 245, 254, Fever, mother
280, 319 breastfeeding (while), 312-313
Employment insurance (maternity and parental leave), 129 postpartum, 227, 228-229, 232, 235, 237
Endocrine conditions, 217 Fibre
Endometriosis, 260 postpartum, 229, 231, 233, 234, 237
Endorphins, 165, 167, 175 pregnancy, 34, 36-37, 101
Energy drinks, 43 Fifth disease (parvovirus/slapped cheek disease), 75
Engorgement, engorged breast (overfilled with milk), Financial information and programs
226-227, 309-310 Adult Health Benefit, 26
Entonox (laughing gas), 194 Alberta Child Health Benefit, 220
Epidural, 194-195 Canada Child Tax Benefit, 220
Episiotomy, 152, 199, 229 Flu (flu-like symptoms)
Escherichia coli (E.coli), 39, 41 breastfeeding, 312-313
Exclusive breastfeeding, 85, 230, 268, 276 influenza immunization, 75-77
Exercise. See physical activity/exercise postpartum, 235
Expressed breastmilk (expressing), 279, 293-299 Fluids (mother)
Eyes (baby’s) postpartum, 229, 231-235, 237, 244, 303, 311-312
postpartum, 208, 212, 225 pregnancy, 34, 36, 41, 61, 77, 96, 101, 151, 167, 173-174, 176
prenatal (during pregnancy), 36, 78, 94 Folic acid (folate), 23, 33-34, 95, 117, 238
Fontanelles (soft spots), 211
F Food guide. See Canada’s Food Guide

Food poisoning/safety (food-borne illness), 38-42
Family doctor, 24, 225
Food servings (mother). See eating (mother)
Family planning. See birth control
Forceps, 195, 200
Family violence. See abuse
Formula feeding. See infant formula
FASD (fetal alcohol spectrum disorder), 67-68
Freezing (local anesthetic), 199
Father/partner
Full term, 18, 211
breastfeeding, 280, 293
Fundal height, 123, 154
labour and birth, 158-159, 173, 175, 183-189, 203, 218
postpartum, 224, 237, 244-245, 247, 251, 254, 259, 280
pregnancy, 12-13, 23, 24, 45, 54, 55, 62, 63, 67, 69, 76, 78, 80,
G
85, 87, 97, 102, 103, 110, 122, 140-141, 153, 158 General anesthetic, 202-203
Feeding cues (baby). See cues (baby) Genetic abnormalities, 106
Feeding your baby (planning ahead), 85-86 Genetic screening and testing, prenatal. 103, 106-107, 125
See also, breastfeeding Genitals (baby), 56, 212
See also, infant formula Genital warts, 56
Fentanyl, 19, 74, 193, 252, 306, 320 Germs, control spread (of), 38, 243
Fetal alcohol spectrum disorder (FASD), 67-68 German measles (rubella), 75-76, 104
Fetal Doppler, 94 Gestational diabetes, 30, 45, 124, 137
Fetal monitoring, 161, 196-197 Giardiasis, 39
Fetal movement, 11, 113, 114, 116, 145, 155, 169 Gingivitis, 53, 99
Fetal well-being ultrasound (biophysical profile), 156 Glucose tolerance test or diabetic testing, 124
Fetus (baby), 17, 94 Gonorrhea, 56, 109
Grain products, 31, 34, 37
Groin pain, 115, 118

Group B Streptococcus (Group B Strep), 154, 198
I
INDEX
Growth, baby and mother (during pregnancy), 91-94,
IM (intramuscular) injection into a muscle, 193
114-116, 145-147
Immune (immunity), 36, 75, 103-104, 129, 146, 298, 301
Growth spurts (baby), 276, 278, 287
Immunizations (immunize, vaccinations)
Guardianship, 14
definition, 75
Gums (baby), 288
during pregnancy, 75-77
Gums (mother), 53, 71, 93, 99, 116, 137
immune/immunity. See immune (immunity)
schedule, 4
H See also, infectious diseases
Hallucinations, 250 Implanting (embryo attaching), 16, 91
Hand expression (of breastmilk), 295 Incision (cut). See also caesarean birth
Hand washing, 38, 75, 80, 213, 229, 242-243, 288, 295, 301-302, Income Tax (returns), 219, 220
305, 311 Incontinence, 49, 233
See also, infectious diseases Indigestion, 115
Hashish (hash oil). See cannabis Inducing labour (induced/induction), 161, 197-198
Hazards/hazardous substances, 23, 83 Infant carrier (baby carrier), 134-135, 159, 240, 221-223
Headache(s), 98, 137, 161 Infant formula (baby formula),
Head shape (baby), 211 deciding, 85-86,
Health Link (811), 3 for information about, 85
Heart rate/beat (baby), 92, 94, 123-124, 156, 161, 196-197 menstrual period (postpartum), 230
Heartburn, 73, 95, 115, 150-151 supplementing, 318-320,
Hemoglobin, pregnancy (mother), 104 Infectious diseases, 75, 80,
Hemorrhoids, 37, 101, 179, 231-232 See also, food poisoning/safety
Hepatitis B, 56, 105 See also, immunization
Herbal products (natural remedies). See medicine, See also, sexually transmitted infections (STIs)
supplements and herbal products Influenza (flu) immunization, 75-77
Herbal teas, 43, 304, 314 Injury prevention, 240-241
Heroin, 19, 74, 252, 306, 320 Iron (baby), 33-35, 95, 101, 147
Herpes, 201, 320 IUD/IUC/IUS (intrauterine contraceptives), 262, 271
High blood pressure (hypertension). See blood pressure IV (intravenous/into a vein), 193
HIV (Human Immunodeficiency Virus), 56, 105, 258-272
Hormones
J
labour and birth, 165-166, 173, 176-177, 210, 212, 217
Jaundice, 225, 317
postpartum, 240. See birth control
pregnancy, 17, 100-101, 119, 124, 146
Hospitals. See birth centres 324
Hot tubs, saunas and hot baths, 80
Household cleaners, 83
HPV (Human Papilloma Virus), 56
Hunger cues (baby). See feeding cues
Hyperemesis gravidarum, 96
Hyperventilate, 188

L M
Labour and birth Malaria, 77-78
augmenting labor (stimulating contractions), 199 Marijuana (Cannabis, hashish, hash oil). See Cannabis
back labor, 181-182 Massage
birth wishes, 126-128 breast, 294
breath control, 186-187 labour and birth, 165, 167, 176, 182, 184
c-section (caesarean birth), 201-204 perineal, 152, 199
contractions. See contractions Mastitis, 311-313
episiotomy, 199 Maternal blood test (prenatal screening), 104-107
fetal monitoring, 196-197 Maternal serum prenatal screen (MSPS/quad screen), 125
first stage: latent, active labor, and transition phases, Maternity and parental leave, 54, 129, 152
172-177 Measles
forceps, 200 German (rubella), 75, 104
inducing labor, 197-198 Red (rubeola), 76
knowing what to expect, 166-171 Meat and alternatives, 31, 42
pain relief, 193-195 Meconium/stool (baby), 277, 289-290
positions for labor, 177-180 Medicine, supplements and herbal products
relaxation techniques, 183-185 breastfeeding, 227, 229
second stage (birthing baby), 190-191 herbal products/natural remedies, 3, 72, 73, 278, 304
support person’s role, 187-189 pain medicine. See labour and birth
third stage (delivery of the placenta), 192 prescription and over-the-counter medication, 25, 72-73,
stages of labor, 171 304, 320
vacuum-assisted birth, 200 vitamins and minerals. See vitamins and minerals
Lactation amenorrhea method (LAM), 268 Menstrual period (period)
Lactose intolerance, 44 after miscarriage, 110
Lanugo, 114, 211 birth control, 257, 260, 268
Latch, 285-286 breastfeeding, 230, 276
Latent phase of labour (early), 171-173 postpartum, 230
Laughing gas (Entonox), 194 pregnancy, 16, 91, 92
Lead, 43, 83-84, 109 Mental health
Leaking milk from (breasts), 313 postpartum. See postpartum (mental health) 335
Leg cramps, 45, 120, 147, 149 pregnancy, 25, 54-66, 102, 121-122, 152-153
Let-down (milk ejection reflex), 277, 311-312, 316 Mercury, 39-40, 42, 303
Lifting, pregnancy (during), 48, 52, 81, 233-234 Metabolic conditions (baby), 217, 320
Lightening, 166 Midwives, 24, 25, 225
Linea nigra, 114 Milia, 211
Listeria (listeriosis), 39, 41-42 Milk, trouble with (lactose-intolerance), 44
Low birth weight, 30, 34, 56, 67, 68, 70, 74, 81, 82, 300 Milk and alternatives, 31, 35
Low iron (anemia), 34, 105 Milk (for baby)
Low-Risk Drinking Guidelines (Canada’s), 250 breastmilk. See breastfeeding
formula, See infant formula, 85-86, 230, 279, 318-320, 322
Milk ejection (let-down), 277, 311, 312, 316
Milk flow (breastmilk), 210, 277, 288, 294-295, 309-312,
315-317

Milk ducts (blocked), 135, 283, 311-312, 315 Nipples (mother)
INDEX
Milk glands, 277 breastfeeding, 308-309, 226-227
Milk supply (breast). See breastmilk (supply) pregnancy, 55, 114, 147
Minerals. See vitamins and minerals shield, 309, 313
Miscarriage Non-stress test (NST), 156
definition/general information, 14, 108-110, 141 Nursing bra, 135
emergency department (go NOW), 108, 110 grief/ Nursing pads (breast pads), 135, 308, 313, 319
support (emotions), 142 Nutrition. See eating
possible causes, 39, 56, 67-68, 70, 78, 81, 83, 105, 107, 109,
125 O
MMR (measles, mumps, rubella) vaccine, 76
Obstetrician, 18, 126
Mood swings, 63, 93, 121
Omega-3 fats, 36, 303
Morning sickness. See nausea
Oral health. See teeth and mouth care
Mosquito-borne infections, 77-78
Osteoporosis, 260
Mucus plug, 166
Over-the-counter medicine (OTC). See medicine,
Multiples, twins, triplets and more. See twins, triplets and
supplements and herbal products
more
Ovaries, 230, 258, 259, 261, 262
Multivitamin. See vitamins and minerals
See also, birth control
Mumps, 76
Ovulate, 230, 257
Oxytocin, 173, 176, 192, 195, 196, 198-199
N
Narcotics, 193 P
Natural family planning, fertility awareness-based (FAB), 269
Packing for birth centre, 159-160
Natural remedies, 73, 96
Pacifier (soother), 215
Nausea
Pain
labour and birth, 175, 190, 193, 194
after pains, 230
pregnancy, 30, 33, 92-93, 96, 114
labour and birth, 165, 167-168, 177, 181, 193-195
Naval (belly button), 17, 146
pregnancy, 50, 108-109, 115, 118-120, 137, 139, 161-162
Neonatal intensive care unit/special care nursery (NICU),
Paint and paint remover (lead-based paints), 83-84
140, 218
Pap test, 103, 225
Nesting, 11, 167
Parental leave 129
Neural tube defects, 23, 33-34
Pasteurized, 39, 41, 318
Newborn baby (how they look), 210-213
Patch, (birth control), 257, 259
Newborn blood spot screen, 217
Pee. See urine
Newborn hearing screening, 217
Pelvic (pelvis)
Nicotine, 68-71, 304
bones, 17
Nicotine replacement therapy, 19, 71
exam, 103, 154
NICU (neonatal intensive care unit/special care nursery),
floor muscles, 49-50, 101, 160, 232-234, 238
140, 218
organ prolapse, 234
Night sweats, 235
outlet, 180, 182
Nipple (baby bottle), 243, 299
tilt, 179-180, 182
See labour and birth
Periodontal disease, 53

Perineum (perineal area) Postpartum (mental health)
care and comfort, 228-229 anxiety, 247, 249
definition, 49 baby blues (postpartum blues), 246-247
episiotomy, 152, 199 depression, 247-249
perineal massage, 152 emergency, 911 (call NOW), 248-249
Period. See menstrual period psychosis, 250
Pertussis (whooping cough), 76 relaxation techniques, 246
Pesticides, 83 self-care, 244-246
Pets and animals, 80 Posture, 46, 50-52, 98
Physical activity/exercise Pre-eclampsia, 137, 161
postpartum, 237-239 Pregnancy care, routine checkups, tests. See trimester, first,
prenatal, 44-48, 117, 148-149 second, third
Pica, 93 Premature/preterm, baby, 138-140, 218
Pill-progestin only ‘mini pill’, 258 Premature/preterm labour
Placenta (placental) call Health Link at 811 or your health care provider,
abruption, 162, 202 (NOW), 139, 164
definition, 17 definition, 137-138
delivery of, 171, 192 possible causes, 30, 34, 67-68, 70, 74, 81
development, 91, 124 signs of, 139, 161-162, 167
eating of (placentophagy), 192 Prenatal care, checkups and tests. See trimester first,
previa, 201 second, third
Plant-based drinks, 43 Prenatal classes/childbirth classes, 87-88, 126
Plaque, 53, 99 Prenatal genetic screening/testing, 103, 106-107, 125
Playpens, 133 Prenatal vitamins. See vitamins and minerals (mother)
Positions Prenatal yoga, 45, 47
breastfeeding, 282-286 Prescription medicine. See medicine, supplements and
during labour (mother), 176-180 herbal products
during labour (baby), 181-182 Progressive relaxation, 183-185
Posterior position, 181-182 Prolapse (umbilical cord), 162, 169, 202
Postnatal. See postpartum Prostaglandin(s), 162, 166, 197, 198
Postpartum, birth centre (at the), 208-223 Psychosis (postpartum psychosis), 250
Postpartum, caring for yourself Public health nurse/community health nurse, 142, 214, 221,
birth control, 257-272 225, 279
comforts for physical changes, 230-235
first few weeks, 224-229, 236-237, 240 Q
healthy eating/physical activity (exercise), 237-239
Quickening, 113-114
mental health. See postpartum (mental health)
relationships, 253-256
visitors, 242, 245, 254, 280
R
Postpartum depression, 247-249 Radiation, 83
See also, postpartum mental health Red measles (rubeola), 76
Reflux, 73, 95
Regional anesthetic, 202-203
Registering a child’s birth, 219

Relationships Sleep, mother
INDEX
postpartum 253-256 positions, 150 postpartum, 240
pregnancy, 55-58 pregnancy, 64, 147, 150
Relaxation techniques Sleep, baby/newborn
labour and birth, 183-185 how much, 287
pregnancy (breathing), 62 safe, 132-133, 215, 292
Reproductive system, 56, 69 sleepy newborn baby, 317
Restricted diets, pregnancy, 43, 303 Small for gestational age, 30
Rh factor/Rh immunoglobulin, 104 Smoking/smoke. See tobacco and tobacco-like
Rickets, 85, 275 products
Rimming/ripening (of cervix), 166 Soft spots (fontanelles), 211
Rubella (German measles), 75-76, 104 Soother (pacifier), 215
Ruptured/rupturing the membranes, 162, 166, 169, 198-199, Sore nipples, 308-309
202 See also, breastfeeding (challenges)
Special care nursery/Neonatal intensive care unit (NICU),
S 140, 218
Spermicide, 257, 266-267
Safe sleep (baby), 215. See also SIDS
Sponge (birth control), 267
Safer sex, 56
Spotting, bleeding. See bleeding, mother
Safety, baby
Stages of labour. See labour and birth (stages)
baby carrier, 241
Standing (pregnancy), 48, 51, 81-82
car seat, 134, 221-223
Staples/stitches (mother), 199, 203, 225
falls, 216
Stem cells, 129
safe sleep. See SIDS
STIs (sexually transmitted infections), 56, 257-271
stroller and carriage, 135
Stillbirth
Salmonella, 40-42
definition, 39
Sauna (hot tubs/hot baths), 80
grief/support, 141-142
Scalp, baby, 197
possible causes, 39-40, 56, 67, 78, 105
Screening (newborn baby), 217
Stools/poops/bowel movements (baby), 289-290
Screening, mother, 103-105, 106-107, 125, 247.
Stools, mother. See bowel movements (mother)
Scuba diving (pregnancy), 48
Stork bites, baby (reddish areas), 211
Seat belt, 79
Street (illicit) drugs, 74-75
Second-hand smoke and vapour. See tobacco and
Streptococcus (Group B Streptococcus), 154, 198
tobacco-like products
Stress management, 45, 61-63, 64, 102, 122, 149, 177, 214, 238,
Sexuality (sexual intercourse)
244, 253
postpartum, 225, 229, 256-257
Stress incontinence, 49
pregnancy, 55-58, 78-79, 102, 123, 154
Stretch marks, 116, 118
Sexually transmitted infections (STIs), 56, 257-271
Sweep membrane (strip), 197
Short(ness) of breath, 147, 150
Sweeteners (alternative), 43
Showering and bathing (postpartum), 226, 236
Supplements, baby
Siblings (other children), 14-15, 254-255
feeding (breastmilk, formula). See feeding your baby
SIDS (sudden infant death syndrome), 68-70, 132-133, 215,
vitamins. See vitamins and minerals (baby)
251, 276
Sitting, 52
Skin-to-skin cuddling, 140, 209-210

Supplements, mother Braxton-Hicks contractions, 113, 116
See medicine, supplements and herbal products call 911 NOW, 120
See vitamins and minerals (mother) checkups, routine tests (prenatal), 123-125
Swelling (swollen) definition, 16, 112-113
breasts. See breastfeeding (challenges) growing together (changes), 113- 116
gums, 53, 93, 116 feeling uncomfortable, 118-121
hands, feet, ankles or calves, 120, 137, 145, 151, 161, 235 mental health, 121-122
Syphilis, 56, 105 planning ahead, 126-136
pregnancy (doesn’t go as expected), 137-142
T sexuality, 123
taking care of yourself, 117
Tea. See caffeine and herbal teas
twins, triplets and more. See twins, triplets and
Teeth and mouth care (mother), 35, 53, 95, 156
more
Temperature (baby). See fever (mother) 330
Trimester, third
TENS (transcutaneous electronic nerve stimulation), 193
birth center (packing for), 159
Tests (prenatal/pregnancy). See trimester, first, second and
checkups, routine tests (prenatal), 154-156
third
definition, 16
Third-hand smoke and vapour, 70, 251, 305
due date (going past), 161
Throwing up (vomiting), 92-93, 96, 114, 290
feeling uncomfortable, 150-151
Thrush (yeast infection), 308
fetal movement count/fetal movement, 155
Tobacco and tobacco-like products (breastfeeding), 304-305
growing together (changes), 145-147
Tobacco and tobacco-like products (postpartum), 3, 19,
mental health, 152-153
68-71, 215, 251-252
perineal massage, 152
Tobacco and tobacco-like products (pregnancy), 3, 19,
taking care of yourself, 148-149
68- 71
planning ahead, 156-160
Too much milk, 315-316
pregnancy (doesn’t go as expected), 161-162
Toothpaste (sodium lauryl sulfate-free toothpaste), 96
preterm labour. See premature/preterm labour
Toxoplasmosis (toxoplasma), 40, 80
sexuality, 154
Transition (phase of labour), 171, 175
twins, triplets and more. See twins, triplets and more
Transverse lie, 201
Trisomy 13, 106-107
Travel/travelling, 77-79
Tubal ligation, 270
Trimester, first
Twins, triplets and more, 18, 37, 125-126, 160, 278
checkups, routine tests (prenatal), 103-107
definition, 16, 90-91
feeling uncomfortable, 96-101
U
growing together (changes), 91-94 Ultrasound, 11, 106-107, 124, 156, 161
mental health, 102 Umbilical cord, 17, 129, 162, 191, 212-213
miscarriage, 108-110, 141 Unpasteurized milk/juice/cheese, 39, 41
planning ahead, 85-88 Urinary tract infection (UTI), 105
sexuality, 102 Urine/pee/wet diapers (baby), 289-290
taking care of yourself, 95 Urine/pee/voids (mother), 49, 100, 105, 232-234
Trimester, second Uterus/womb, 17, 172, 190, 208, 227, 230
birth wishes, 127-128 See also, contractions

V W
INDEX
Vaccine/vaccination, 75-76 Washing hands, 38, 75, 80, 213, 229, 242-243, 288, 295,
See also, immunizations 301-302, 305, 311
Vacuum assisted birth, 195, 200 See also, infectious diseases 331
Vagina (mother), 17 Water breaks (ruptured membranes), 162, 166, 169, 174-175,
Vaginal birth after a caesarean (VBAC), 201 198-199, 202
Vaginal bleeding. See bleeding, mother Weaning, from breastfeeding. 318-319
Vaginal contraceptive ring, 261 Weight gain
Vaginal discharge (baby), 212 gain, 26-30
Vaginal discharge tracking, 28
emergency, 911 (call NOW), 227 twins, triplets and more, 37
labour and birth, 173-174 Weight loss (postpartum), 239, 276
postpartum, 227 Well water, 43
pregnancy, 115, 119, 139 Whooping cough (pertussis), 76
Vaginal spermicides, 266 Working/employment, 81-82
Vaping (vapour). See tobacco and tobacco-like
products Y
Varicella (chicken pox)/varicella titre, 7, 104
Yeast infection (thrush), 308
Varicose veins, mother
YES Test (car seat safety), 221-223
changes in you, 116, 120, 147
See also car seat
emergency 911 (call NOW), 120
Yoga (prenatal), 45, 47
Vasectomy, 270
VBAC (vaginal birth after a caesarean), 201
Vegan diet, 43, 303
Z
Vegetables and fruit, 31, 38, 41 Zika virus, 77-79
Vegetarian, 43, 303
Vernix, 115, 210
Violence, family (domestic), 56-60
Visitors, postpartum, 218, 242, 245, 254, 280
Vitamins and minerals (baby)
calcium, 85, 275
iron, 147
vitamin D, 85, 210, 275-276
vitamin K, 208
Vitamins and minerals (mother)
calcium, 35, 43
folic acid (folate), 23, 33-34, 95, 238
iron, 33-34, 101, 104
important vitamins and minerals, 23, 33-37, 95, 96, 117,
238
multivitamin (with folic acid), 23, 33-34, 95-96, 117, 238
omega-3 fats, 36, 303
vitamin A/vitamin B12/vitamin D, 33, 35, 36, 43, 95, 238
Vomiting, mother, 92-93, 96, 114 See also, nausea
Vomiting, baby, 290

H E A LT H Y PA R E N T S , H E A LT H Y C H I L D R E N
Pregnancy & Birth

Healthy Parents, Healthy Children: Pregnancy and Birth is filled with everything that
expectant parents want and need to know about pregnancy and birth in Alberta.
From the three trimesters of pregnancy to breastfeeding your baby, this book covers
relevant, up-to-date information about how to have the healthiest pregnancy and
baby possible.
A practical guide to pregnancy and becoming a parent, Healthy Parents, Healthy

Children: Pregnancy and Birth is the reliable, go-to source if you’re asking yourself:
Where do I go from here?
You can also find this book online at healthyparentshealthychildren.ca
Follow us on
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@AHS_HPHC

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& Birth

Because they don’t come with a manual

Your baby’s due date:

My important contact information

Community or public health centre

This book has lots of information to help you through your

The content in this book reflects Alberta

Important Contact Information 3

FIRST TRIMESTER: THE BEGINNING 89

SECOND TRIMESTER: THE MIDDLE 111

Growing Together 113

Growing Together 145

LABOUR & BIRTH: THE BIG EVENT 163

Knowing What to Expect 165

Congratulations Your Baby is Here! 207

Breastfeeding Your Baby 275

2 Pregnancy and Birth | Healthy Parents, Healthy Children

Emergency Services Health Link

Addiction AlbertaQuits Helpline Bullying Helpline

Child Abuse Family Violence Income Support

Medication & Mental Health Poison & Drug

myhealth.alberta.ca alberta.ca immunizealberta.ca

4 Pregnancy and Birth | Healthy Parents, Healthy Children

Families are as unique as the people

Healthy Parents, Healthy Children | Pregnancy and Birth 5

We refer to hospitals and midwifery run birth centres as ‘birth centres’.

6 Pregnancy and Birth | Healthy Parents, Healthy Children

■ text boxes that highlight:

Things to know Helpful activities

■■ text boxes that describe when to ask for help:

1. Open a QR code reader on your smart phone.

Healthy Parents, Healthy Children | Pregnancy and Birth 7

We also wish to acknowledge these organizations from which we adapted content:

8 Pregnancy and Birth | Healthy Parents, Healthy Children

Attachment begins in pregnancy

During the second trimester, your baby

Ways to support a pregnant woman

■■ Go to childbirth education and

12 Pregnancy and Birth | Healthy Parents, Healthy Children

Here are some things you may want to think about:

Parenting without a partner

If you have other children

Even though your children may not

miscarriage: loss of a fetus before 20 weeks of pregnancy

14 Pregnancy and Birth | Healthy Parents, Healthy Children

Parenting is a skill you learn as you go. There

~ Meena, mom of two children

Pregnancy is divided into 3 trimesters:

To use an interactive tool on the 3 trimesters, visit the Tools section at

16 Pregnancy and Birth | Healthy Parents, Healthy Children

Rectum Pelvic bones

bowel movements: solid waste from the digestive tract.

Twins, triplets and more

“ Learning from others helped me

~ Liz, expectant mom of twins

18 Pregnancy and Birth | Healthy Parents, Healthy Children

5 weeks 11 weeks 20 weeks 40 weeks

neurons: nerve cells found in the brain and nervous system

interactions: activities and communication between 2 or more people, or their environment

20 Pregnancy and Birth | Healthy Parents, Healthy Children

You may already be doing these things or you may

You can look to your partner, your health care

■■ family doctors: medical doctors who